# Socioeconomic disparities in health-related quality of life and healthcare use in the last year of life of patients with advanced cancer: longitudinal results from the eQuiPe study

## TL;DR

This study finds that patients with advanced cancer and lower income face greater financial strain and use healthcare more often in their final year of life.

## Contribution

The study provides longitudinal evidence of socioeconomic disparities in healthcare use and financial burden in advanced cancer patients.

## Key findings

- Lower socioeconomic position (SEP) is linked to higher disease-related financial difficulties in the last year of life.
- Patients with lower SEP had more frequent healthcare interactions than those with higher SEP.
- No significant associations were found between SEP and HRQoL or hospital admissions.

## Abstract

To examine socioeconomic disparities in health-related quality of life (HRQoL) and healthcare use during the last year of life of patients with advanced cancer.

Data was used from a prospective, longitudinal, multicenter, observational study of patients with advanced cancer in forty Dutch hospitals (eQuiPe). Adult patients with stage IV cancer completed 3-monthly questionnaires until death. Socioeconomic position (SEP) was defined as estimated income on street-level. Mixed-effects regression analysis was used to identify associated factors.

A total of 639 patients were included, 14% with a lower SEP, 59% medium SEP and 28% higher SEP. Patients with a lower SEP were more often lower educated (40% vs. 18%, p < 0.001) and less often reported to have a partner (61% vs. 90%, p < 0.001) than those with a higher SEP. In the last year of life, patients with lower SEP were more likely to experience disease-related financial difficulties than those with higher SEP (28% vs. 12%, p = 0.001; β 8.2, 95%CI 2.9–13.3). No significant associations were found between SEP and HRQoL, hospital admissions or emergency department admissions. Although, patients with lower SEP had more frequent (≥ 5 per month) interactions with healthcare professionals than patients with higher SEP in the last year of life (OR 1.9, 95%CI 1.0–3.5).

Some socioeconomic disparities are present during the last year of life of patients with advanced cancer. It is important for clinicians to be aware of the greater financial impact and higher healthcare utilization in patients with a lower SEP to ensure equitable end-of-life care.

The online version contains supplementary material available at 10.1007/s00520-025-09309-9.