Disparities in receipt of palliative interventions across disaggregated Hispanic subgroups with late-stage colon cancer in the United States.

Abstract

12078 Background: Palliative interventions, defined as cancer-directed therapies with palliative intent, improve the quality of life and alleviate suffering for patients with advanced cancer. Limited research examines disparities in their receipt across disaggregated Hispanic subgroups. We analyzed palliative intervention receipt among Hispanic patients with stage IV colon cancer. Methods: Using the National Cancer Database, we retrospectively analyzed adults diagnosed with stage IV colon cancer (2004–2021) with known palliative intervention receipt status (defined binarily). We performed logistic regressions to characterize palliative intervention receipt rates across a) broad racial groups and b) country of origin, relative to Non-Hispanic White patients (alpha<0.05). Regressions included a race*year interaction term to examine changes in palliative intervention receipt over time (alpha<0.1). Results: We analyzed 1,021,293 patients;3.24% (n=33,132) received palliative interventions. Hispanic Black patients were 0.55x as likely (P=0.030) to receive palliative interventions as non-Hispanic White patients. The year*race interaction term was significant for Hispanic-Black patients, suggesting that invention rate improvements were distributed unequally over time. Specifically, the rate of intervention receipt among Hispanic Black patients decreased from 5.4% in the 2004–2012 cohort to 4.6% in the 2013–2021 cohort (95% CI: 0.32–0.94, P interaction = 0.030), compared to greater decreases observed in the reference group. When disaggregated, Mexican patients were 31% less likely (P=0.006), Cuban patients 35% less likely (P=0.043), NOS patients were 33% less likely (P<0.001), and Dominican Republic patients nearly twice as likely (P=0.009) to receive interventions compared to non-Spanish, non-Hispanic patients. Conclusions: Hispanic Black, Mexican, Cuban, and NOS patients experienced lower receipt of palliative interventions, revealing disparities in access to equitable cancer-directed end-of-life care. Efforts should be made to expand palliative intervention access for diverse racial/ethnic groups. Receipt of palliative care by country of origin. Racial/Ethnic Group % Patients receiving palliative care(All Years) % Patients receiving palliative care(2004-12) % Patients receiving palliative care(2013-21) Non-Spanish, Non-Hispanic White 3.35 2.31 4.30 Mexican 2.74 1.86 3.33 Puerto Rican 3.66 2.49 4.53 Cuban 2.40 1.60 3.48 South/Central American (ex. Brazil) 3.26 1.74 4.28 Other Specified Spanish/Hispanic 3.26 2.55 4.09 NOS 3.16 2.03 3.84 Spanish Surname only 2.80 1.49 4.16 Dominican Republic 4.18 4.96 3.80