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60 Background: Due to the rising incidence of neuroendocrine tumors (NETs), the prevalence of NETs now surpasses many other malignancies. Due to a slower course of disease and lack of awareness among care teams, end-of-life (EOL) care is typically underutilized in patients with NETs. Owing to a heavy symptom burden (related to disease burden and/or functionality), patients with NETs often struggle due to lack of palliative care and eventually EOL care support. Prior studies have revealed that Black patients with advanced cancer are more likely to receive aggressive care and suffer a significant decline in quality of life at EOL. However, similar data investigating racial differences in EOL among patients with NETs are lacking. Methods: The National Inpatient Sample (NIS) was queried between years 2016-2020 to identify all hospitalizations (regardless of site of origin) with NETs utilizing the appropriate ICD-10 codes (neuroendocrine carcinomas were excluded). Hospitalizations of White and Black patients with documented inpatient mortality events were then extracted. Demographic and clinical data were analyzed using independent sample t-test, Chi-square test, and binary logistic regression (adjusted for age, gender, and Charlson comorbidity index or CCI). NIS discharge weights were applied to calculate national estimates. Statistical analyses were performed with SPSS 28.0. A p-value of <0.05 was considered statistically significant. Results: A total of 6,265 hospitalizations with NETs were included, of which 5,125 (81.8%) and 1,140 (18.2%) had White and Black patients respectively. Black patients were younger, more likely to be females, and less likely to have a do not resuscitate (DNR) code status. There was no significant difference in CCI between the groups. Palliative care consultation was less likely to be performed among Black patients (adjusted OR=0.70, p<.001). Black patients also had longer mean length of stay in the hospital (10.25 vs 8.42 days, p<.001). Black patients were also more likely to receive aggressive care in the form of mechanical ventilation at EOL (Table). Conclusions: This is the largest analysis demonstrating significant racial disparities in EOL care among patients with NETs. Black patients had longer inpatient stay, were less likely to receive inpatient palliative care consultation, have a DNR order and more likely to receive aggressive care at EOL. These findings may have implications for informing healthcare decision making for EOL care among Black patients with NETs. WhiteN=5125 BlackN=1140 aOR (95% CI) p-value Age (years) 67.67 ± 11.89 65.14 ± 11.29 - <.001 Females 46.1% 50.9% - .004 CCI 11.0 ± 3.22 10.9 ± 3.42 - .538 Mean length of stay 8.42 ± 10.03 10.25 ± 15.75 - <.001 Palliative 62.6% 54.5% 0.70 (.61-.80) <.001 DNR 64.9% 60.1% 0.80 (.70-.92) .002 Blood transfusion 13.2% 15.4% 1.18 (.98-1.41) .052 Mechanical ventilation 28.8% 38.6% 1.55 (1.35-1.77) <.001 Vasopressor 9% 9.6% 1.07 (.86-1.33) .47
Baskar et al. (Mon,) studied this question.