Sex-Based Analysis of Quality Indicators of End-of-Life Care in Gastrointestinal Malignancies

TL;DR

The study finds that fewer female patients with gastrointestinal cancers receive aggressive end-of-life care compared to males.

Contribution

This paper provides new insights into sex-based differences in end-of-life care quality for gastrointestinal cancer patients.

Findings

A smaller proportion of females received aggressive end-of-life care compared to males (14.3% vs. 19.0%).

Younger females (18–39 years) had higher odds of receiving aggressive care than older females.

Rates of supportive care increased over time for both sexes, while aggressive care rates remained stable.

Abstract

Indices of aggressive or supportive end-of-life (EOL) care are used to evaluate health services quality. Disparities according to sex were previously described, with studies showing that male sex is associated with aggressive EOL care. This is a secondary analysis of 69,983 patients who died of a GI malignancy in Ontario between 2006 and 2018. Quality indices from the last 14–30 days of life and aggregate measures for aggressive and supportive EOL care were derived from administrative data. Hospitalizations, emergency department use, intensive care unit admissions, and receipt of chemotherapy were considered indices of aggressive care, while physician house call and palliative home care were considered indices of supportive care. Overall, a smaller proportion of females experienced aggressive care at EOL (14.3% vs. 19.0%, standardized difference = 0.13, where ≥0.1 is a meaningful difference). Over time, rates of aggressive care were stable, while rates of supportive care increased for both sexes. Logistic regression showed that younger females (ages 18–39) had increased odds of experiencing aggressive EOL care (OR 1.71, 95% CI 1.30–2.25), but there was no such association for males. Quality of EOL care varies according to sex, with a smaller proportion of females experiencing aggressive EOL care.

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