A retrospective cohort study using the NCDB (2012–2023) evaluated national trends and disparities in palliative-intent therapy utilization among 43,443 adults with stage IV rectal adenocarcinoma.
Palliative therapy use rose from 16.2% (2012) to 25.6% (2023); systemic therapy became the dominant modality while surgical palliation declined. Lower income (OR 1.82), brain metastases (OR 5.75), and immunotherapy use (OR 1.65) independently predicted palliative therapy receipt; primary tumor resection was inversely associated (OR 0.45).
Retrospective NCDB design limits causal inference; the NCDB palliative-intent variable may not fully capture nuanced clinical intent; survival, quality-of-life, and symptom outcomes are not available in this dataset.
Palliative-intent therapy in stage IV rectal cancer is increasingly systemic rather than surgical — clinicians should actively integrate palliative care pathways, particularly for lower-income patients and those with brain metastases who show higher utilization rates. Rising immunotherapy use in this setting warrants attention as an emerging palliative modality.
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