Disparities in the Receipt of Palliative-Intent Treatment Among Disaggregated Hispanic Populations With Stage IV Liver Cancer in the United States

Objectives: Our study investigates disparities in receipt of palliative-intent care among broad racial/ethnic and disaggregated Hispanic subgroups with stage IV liver cancer. Methods: This retrospective cohort study included patients with stage IV liver cancer diagnosed between 2004 and 2021 from the National Cancer Database. The primary outcome was the receipt of palliative-intent intervention. Multivariate regressions controlling for age group, country of origin, year group, sex, insurance status, 2016 median income quartiles, facility type, Charlson-Deyo comorbidity index score, stage group, and facility location quantified disparities in palliative-intent intervention. Further difference-in-differences analyses were conducted. Results: Among 37,987 patients with stage IV liver cancer, 6573 (17.30%) received palliative-intent treatment. Compared to non-Hispanic White (NHW) patients, disaggregated analyses revealed significantly lower odds of receiving palliative-intent interventions for Black patients (AOR=0.93, 95% CI: 0.86-1.00, P =0.050) and patients of Hispanic descent (AOR=0.76, CI: 0.69-0.84, P <0.001). Furthermore, patients with stage IV liver cancer of Mexican and Cuban descent had lower odds of obtaining palliative-intent treatment compared with NHW patients (AOR=0.70, 95% CI: 0.54-0.90, P =0.006; AOR=0.44, 95% CI: 0.19-1.02, P =0.056). Difference-in-differences analyses revealed a significant association between palliative-intent intervention and 2014 to 2021, suggesting potential temporal differences in the primary outcome. Conclusions: Our study highlights the significant disparities in receipt of palliative-intent care among Hispanic subgroups upon disaggregation, underscoring the need for continued disaggregated research and targeted community- and patient-level solutions to close care gaps.