Black Patients Less Likely to Receive Anti-Cancer Therapy at End of Life

A new study indicated that Black patients with cancer were less likely to receive anti-cancer therapy at the end of life (EOL). These results contrast with previous research that has indicated that Black patients are more likely to receive aggressive EOL care.

Findings were from a retrospective cohort study of data from the nationwide Flatiron Health electronic health record-derived de-identified database. The study included patients with confirmed cancer diagnosis with treatment on or after January 1, 2011, who died between 2015 and 2019.

The study included 40,675 White patients and 5,150 Black patients. Black patients were younger at diagnosis, more likely to be female, and more likely to have Medicaid coverage.

Additionally, Black patients were more likely to be treated at practice with high patient-to-physician ratios.

Compared with White patients within the same practice, Black patients were 13% less likely to receive any EOL treatment within 30 days (adjusted odds ratio [aOR] = 0.87; 95% CI, 0.81 to 0.93) or 14 days (aOR = 0.87; 95% CI, 0.80 to 0.96).

The adjusted rates of any EOL treatment within 30 days prior to death were 33.8% for Black patients and 37.6% for White patients.

These differences in treatment may be, in part, to less use of immune checkpoint inhibitors within 30 days prior to death for Black patients compared with White patients (aOR = 0.87; 95% CI, 0.76 to 1.00).

According to the researchers, future research should investigate patient and practice-level factors to understand potential causal pathways underlying observed racial differences. These might include insurance status, patient-to-physician ratio, or potential treatment biases.