Sex and Racial/Ethnic Differences and Trends in Cancer Patient Experience and Communication in the Last Year of Life Among Elderly U.S. Medicare Beneficiaries: A National Analysis of SEER-CAHPS Data, 2000-2019

Introduction: Effective communication is key to quality end-of-life care. This study assessed sex, racial/ethnic, and temporal differences in perceived experience and communication among elderly U.S. Medicare patients with cancer in the last year of life. Methods: The Surveillance, Epidemiology, and End Results (SEER)-Consumer Assessment of Healthcare Providers and Systems (CAHPS) data resource from 2000-2019 was used. Multivariable, survey-weighted linear regression models assessed sex, racial/ethnic, and temporal differences in patient experience and communication at the end of life. Results: A total of 10,108 patients were included. Women had higher “rate care” scores compared with men. No significant differences in ratings were found between non-Hispanic Black and non-Hispanic White patients nor between Hispanic and non-Hispanic White patients. Surveys completed during 2012-2019 had higher “rate MD” and “doctor communication” ratings but a lower rating for “getting needed care” compared with surveys completed between 2000-2011. Conclusion: Overall, there were small differences in end-of-life patient experience and communication by sex or race/ethnicity among older adults with cancer. Improvements in reported communication over time may reflect changes in care delivery and information access, while lower ratings for “getting needed care” suggest persistent challenges in care access during the last year of life, highlighting opportunities to improve patient-centered end-of-life care.