Retrospective cohort study of trends in the use of palliative therapy in stage IV rectal cancer in the United States

Palliative-intent therapies are a key component in the management of metastatic rectal cancer. A retrospective cohort study using the National Cancer Database investigated trends in the use of palliative therapy in stage IV rectal cancer in the United States from 2012 to 2023. A total of 43 443 stage IV rectal cancer patients were included, of whom 8931 (20.6%) received palliative-intent therapy. Utilization of palliative-intent therapy increased significantly over time, from 16.2% in 2012 to 25.6% in 2023 (p<0.001). Systemic therapy was the most frequently used modality, and increased over time, while surgical palliation declined substantially. Immunotherapy use rose markedly in later years. Palliative therapy utilization increased across all facility types and across all income strata, with the most pronounced rise among patients from lower-income areas. On multivariable analysis, lower income (OR 1.82; 95% CI 1.21-2.74), brain metastases (5.75; 1.76-18.70) and immunotherapy use (1.65; 1.24-2.21) were independently associated with increased odds of receiving palliative therapy, whereas primary tumor resection was associated with reduced utilization (0.45; 0.32-0.61). The authors conclude that in this large national cohort, palliative therapy utilization increased modestly over time, with a shift from surgical to systemic approaches.