Disparities in receipt of chemotherapy at the end of life among patients with NSCLC.

• DOI: 10.1200/jco.2025.43.16_suppl.e13746
• Publication Date: 2025-05-28T15:41:10Z
• Authors: Khushi Kohli; Stephanie Wang; Shriya Garg; Erin Feliciano; Puneeth Iyengar; Edward Christophe...

e13746

Background: Chemotherapy near end-of-life (EOL) may not prolong survival and can cause unnecessary suffering. Little work has explored disparities in futile EOL care receipt among AANHPI subgroups. Using chemotherapy receipt within 30 days of death as a proxy for EOL, we examined disparities in futile treatment for disaggregated AANHPI patients with non-small cell lung cancer (NSCLC). Methods: Using the National Cancer Database, we conducted a retrospective analysis of adult patients diagnosed with NSCLC (2004-2021) who died within 30 days of diagnosis and had known chemotherapy receipt (defined binarily). Using StataMP 18, we calculated adjusted odds ratios and 95% confidence intervals of chemotherapy receipt across racial/ethnic groups using a logistic regression (alpha < 0.05). The regression included a year*race interaction term to examine changes in futile chemotherapy receipt over time by race (alpha < 0.1). Results: 119,046 individuals died within 30d of diagnosis. Patient demographics were as follows: 85.9% White (n = 102,130), 10.81% Black (n = 12,874), 0.52% Southeast Asian (n = 617), 0.72% East Asian (n = 853), 0.15% South Asian (n = 175), 0.29% American Indian/Aleutian/Eskimo (n = 349), 0.13% Pacific Islander (n = 158) 1.59% Other (n = 1,890). Chemotherapy was administered for 7.1% of White, 5.7% of Black, 5.8% of Southeast Asian, 8.1% of East Asian, 9.7% of South Asian, 6.3% of American Indian/Aleutian/Eskimo, 3.8% of Pacific Islander, and 6.6% of Other patients. East Asian patients were 1.42x more likely (P = 0.028), Black patients were 0.77x as likely (P < 0.001), and Southeast Asian patients were 0.59x as likely (P = 0.037) to receive chemotherapy than White patients. Southeast Asian patients diagnosed from 2013-2021 were 1.95x more likely (P = 0.055) to receive chemotherapy than White patients diagnosed from 2013-2021, suggesting a significant increase in futile chemotherapy receipt for SE Asian patients. The year*race term was significant for SE Asian patients, suggesting that the lower rate of futile chemotherapy over time was not equitably distributed (SE Asian cohort: 5.4% for 2004-2012 cohort; 6.3% for 2013-2021 cohort; 95% CI: 0.99-3.85, P interaction = 0.055, compared with decreases for the reference group). Conclusions: We found increased odds of futile chemotherapy for SE Asian patients in more recent years, suggesting trends of burdensome treatment for this group. We should facilitate values-concordant EOL care for diverse patients.

Chemo receipt by racial/ethnic group & diagnosis year for NSCLC patients who died within 30 days of diagnosis.

Racial/Ethnic Group %Patients Receiving Futile Chemo (All Years) %Patients Receiving Futile Chemo (2004-2012) %Patients Receiving Futile Chemo (2013-2021)

White 7.1 8.3 5.5

Black 5.7 6.7 4.6

SE Asian 5.8 5.4 6.3

E Asian 8.1 10.1 5.8

S Asian 9.7 12.5 7.4

American Indian/Aleutian/Eskimo 6.3 8.2 4.5

Pacific Islander 3.8 7.2 1.1

Other 6.6 8.1 5.1