Sex and Racial/Ethnic Differences in End-of-Life Care in Texan Medicare Colorectal Cancer Decedents

BackgroundThere are known sex and racial/ethnic differences in colorectal cancer care. The purpose of this study is to investigate these differences in end-of-life health care utilization, advance care planning, and associated outcomes among Texan Medicare colorectal cancer decedents.MethodsIn this retrospective case control study, we used the Texas Cancer Registry linked with Medicare data for patients (n = 5757) aged ≥66 years who died 6 months to 5 years after receiving a diagnosis of primary colorectal cancer from 2010-2018. We used chi-square tests, t-tests, or ANOVA as appropriate for outcomes in the last 30 days of life to assess sex and racial/ethnic differences. Multivariable logistic regression models were used to assess differences in the odds of inpatient admission and hospice enrollment.ResultsSignificantly more female decedents were hospice enrolled. Non-Hispanic Black decedents, and to a lesser extent Hispanic decedents, had greater health care utilization, including inpatient stays, and less hospice enrollment compared to non-Hispanic White decedents. Advance care planning was low (≤2.2%) across all groups, with no significant differences. Multivariable logistic regression models showed that female decedents had greater odds of hospice enrollment compared to male decedents, and non-Hispanic Black decedents had greater odds of inpatient stays and decreased odds of hospice enrollment compared to non-Hispanic White decedents.ConclusionSex and racial/ethnic disparities in care highlight opportunities for process and quality improvement and suggest a need for practice changes to improve access to quality end-of-life care. More work is needed to incorporate advance care planning and billing into regular workflows.