OBJECTIVES: We aimed (1) to identify and characterize patients with rectal cancer (RC) in the end of life phase in claims data, and (2) to describe treatment patterns and costs for different time periods, stratified by gender.

METHODS: We identified all patients who died in 2021 with a diagnosis of RC (ICD-10 GM: C20) and metastases (ICD-10 GM: C78/79) within 30 (inpatient) or 90 (outpatient) days before death in the AOK PLUS claims dataset covering 3.5 million patients in Germany. Chemo-, radio-, and chemoradiotherapy, surgery, palliative therapy, and targeted therapies as well as costs per patient-year were assessed for five periods: 12-6, 6-3, 3-2, 2-1, and 1-0 months before death and stratified by gender.

RESULTS: We identified 252 RC patients (63% male; mean age: 71.6 years, SD: 11.2 years). Men were younger compared to women (mean age: 69.3 vs. 75.6 years) and had fewer comorbidities (CCI: 7.9 vs. 8.7 points). Closer to death, patients received less RC treatment: chemotherapy decreased from 42% 12-6 months to 12% 1-0 months before death. Contrary, palliative treatment increased during these periods from 56% to 77%. Men received all treatments more frequently compared to women. Differences were largest for targeted therapies (32% vs. 24% 12-6 months before death) and chemotherapy (45% vs. 37%, same period). Total costs were higher closer to death, with about 35% of the annual costs occurring in the last month of life and hospital costs as most expensive item. Due to higher hospital and prescription costs, total costs were higher for men compared to women.

CONCLUSIONS: We found gender disparities in treatment patterns and costs for men vs. women. Given the higher mean age and CCI score found in women, further analyses considering these would be of high interest to find out whether found differences were due to gender or the comorbidity profile of patients.