Palliative treatment disparities in metastatic colon cancer: US retrospective cohort study with disaggregated ethnic groups.

Abstract

Background: Palliative care is important in addressing the needs of patients and their caregivers holistically, particularly where patients are diagnosed with an advanced cancer such as metastatic colon cancer. Racial or ethnic disparities in the receipt of palliative treatment have not been well studied.

Methods: Data from the National Cancer Database were used to identify patients with metastatic colon cancer. Patients were categorised into one of the following racial or ethnic groups: White, Black, Southeast Asian, East Asian, South Asian, Native Hawaiian or Other Pacific Islander (NHPI), other Asian and American Indian, Aleutian or Eskimo. The dependent variable was the receipt of palliative treatment, while the independent variable was the patients' racial or ethnic group. Multivariable logistic regressions were performed to derive the adjusted ORs (AOR) and p values.

Results: Relative to White patients, patients who identified as Black, Southeast Asian or other Asian were less likely to receive palliative treatment (Black AOR=0.944, 95% CI 0.905 to 0.985, p=0.008; Southeast Asians AOR=0.678, 95% CI 0.553 to 0.830, p<0.001; other Asian AOR=0.781, 95% CI 0.637 to 0.957, p=0.017). However, NHPI patients had greater odds of receiving palliative treatment (NHPI AOR=1.696, 95% CI 1.267 to 2.271, p<0.001).

Conclusions: Black, Southeast Asian or other Asian patients had decreased odds of receiving palliative treatment, while NHPI patients had greater odds of receiving palliative treatment, compared with White patients. Further studies are needed to disaggregate reasons behind these disparities in the receipt of palliative treatment.