Low Socioeconomic Status Is Associated With More Aggressive End-of-Life Care for Working-Age Terminal Cancer Patients

Background.The relationship between low socioeconomic status (SES) and aggressiveness of end-of-life (EOL) care in cancer patients of working age (older than 18 years and youngerthan65years)isnotclear.Weassessedtheassociation between aggressiveness of EOL care and differences in SES among working-age terminal cancer patients from Taiwan between 2009 and 2011. Methods. Atotalof32,800cancerdeathswereidentifiedfrom theTaiwanNationalHealthInsuranceResearchDatabase.The indicators of aggressive EOL care (chemotherapy, more than one emergency room [ER] visit or hospital admission, more than 14 days of hospitalization, intensive care unit [ICU] admission, and death in an acute care hospital) in the last month of life were examined. The associations between SES and the indicators were explored. Results. Upto81%ofthecancerdeathspresentedatleastone indicator of aggressive EOL care.Those who were aged 35–44 yearsandmale,hadlowSES,hadmetastaticmalignantdisease, lived in urban areas, or were in hospitals with more abundant health care resources were more likely to receive aggressive EOL care. In multilevel logistic regression analyses, high-SES cancer deaths had less chemotherapy (p , .001), fewer ER visits (p , .001), fewer ICU admissions (p , .001), and lower ratesofdyinginacutehospitals(p,.001)comparedwithlowSES cancer deaths. Conclusion.Working-age terminal cancer patients in Taiwan received aggressive EOL care. EOL cancer care was even more aggressive in those with low SES. Public health strategies should continue to focus on low-SES patientsto provide them with better EOL cancer care.The Oncologist 2014;19:1–8