Trends and disparities in end-of-life care among patients with pancreatic cancer.

Abstract

e16389 Background: Pancreatic cancer is one of the most lethal cancers in the United States (U.S.), with a five-year survival rate of only 12% due to late diagnosis and aggressive progression. End-of-life (EOL) care is often needed for these patients, yet data on EOL care for pancreatic cancer are limited. This study evaluates trends and disparities in EOL care by examining location of death across demographics. Methods: Our population-based retrospective study analyzed death certificate data from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) from 2003 to 2020 to determine the longitudinal trends of place of death for pancreatic cancer deaths at the age of 35 years and above in the U.S.. We used linear regression to test the proportions of deaths in different locations, and stratified the data by race and ethnicity. Odds ratios were calculated using 2x2 contingency table. Results: From 2003 to 2020, pancreatic cancer accounted for 690,950 deaths in the U.S. Most of these deaths occurred at the deceased's home (48.52%), followed by medical facilities (23.58%), nursing home/long-term care (LTC) (11.49%), hospice facility (10.56%), and other locations (5.85%). Deaths at hospice facilities and homes increased significantly from 0.70% to 11.85% (p < 0.01) and from 46.53% to 58.01% (p < 0.01) respectively. Conversely, nursing home/LTC and medical facilities deaths decreased from 14.32% to 6.84% (p < 0.01) and from 28.81% to 16.93% (p < 0.01) respectively. Hospice facility deaths increased among Whites (0.52% to 9.46%, p < 0.01), African Americans (AA) (0.07% to 1.45%, p < 0.01), Hispanics (0.06% to 0.62%, p < 0.01), and Asians (0.05% to 0.25%, p < 0.01). Home deaths also increased among Whites (39.11% to 44.90%, p < 0.01), AA (4.17% to 5.95%, p < 0.01), Hispanics (2.21% to 4.74%, p < 0.01), and Asians (0.80% to 2.08%, p < 0.01). Meanwhile, medical facility deaths decreased significantly among Whites (21.46% to 11.42%, p < 0.01), AA (4.69% to 3.14%, p < 0.01), and Hispanics (1.66% to 1.45%, p < 0.01). Hispanics, AA, and Asians had lower odds of dying in hospice facility (Odds ratio [OR]: 0.84 [95% CI, 0.82–0.86] vs 0.97 [95% CI, 0.96–0.98] vs and 0.66 [95% CI, 0.64–0.68] and higher odds of dying in medical facilities (OR: 1.35 [95% CI, 1.34-1.36], 1.91[95% CI, 1.90-1.92], and 1.56 [95% CI, 1.54-1.58]) than Whites. Conclusions: From 2003 to 2020, there was a shift toward hospice and home deaths, but racial and ethnic disparities remain. These findings underscore the need to address disparities in EOL care.