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

Abstract

Purpose: 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. Methods: 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. Results: 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). Conclusion: 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.