Palliative care referral and utilization patterns among patients diagnosed with metastatic lung cancer within an urban safety-net hospital system.

115 Background: Early integration of palliative care (PC) for patients with metastatic lung cancer may improve quality of life, reduce healthcare utilization, and increase survival. Although professional societies such as ASCO recommend early integration of PC in the setting of metastatic cancer, PC remains underutilized and is often initiated late in disease course, particularly in safety-net hospitals where structural and sociodemographic disparities may further impede access. Understanding the patterns and determinants of PC referral and utilization is essential to identify gaps and inform quality improvement efforts. In this study, we examine PC referral and utilization among patients with metastatic lung cancer at an urban safety-net hospital system. Methods: We conducted a retrospective analysis of all patients diagnosed with metastatic lung cancer between 2022 and 2024 within our safety-net hospital system. Exclusion criteria included patients who were never seen in oncology clinic due to death or being transitioned to hospice. Demographic variables included age, sex, insurance status (uninsured, private, Medicaid/Medicare, other), and race/ethnicity (White, Black, Hispanic, Asian). The date of diagnosis was defined as the date of tissue-confirmed biopsy. Primary outcomes included the date of PC referral and the date of the first completed PC visit. T-tests and Chi-squared tests were utilized to assess associations between sociodemographic variables and receipt of a palliative care referral. Results: Among 163 patients (52.1% men) diagnosed with metastatic lung cancer between 2022 and 2024, 84 (51.5%) received a referral to PC. The median age of the cohort was 64 years; 46.2% were Black and 27.7% were Hispanic; 56.3% were uninsured. There were no significant differences in age, insurance status, race/ethnicity, or sex between patients who received a PC referral and those who did not. Less than a third of patients (53; 32.5%) completed a visit with PC, with 32 (19.6%) completing a PC visit within 8 weeks of diagnosis. The median days (interquartile range - IQR) between date of diagnosis and date of referral placement was 42 (15-103). Of the patients who were referred to PC, half had a referral at the time of or prior to their first oncology visit. The median days (IQR) from referral to PC visit was 49.5 (24-69). Conclusions: In our cohort, PC service was heavily underutilized regardless of patient demographics. Only 20% of patients completed a PC visit within the 8 weeks of their diagnosis. Given the time frame from PC referral to PC visit in our resource limited setting, late referrals can significantly contribute to care delays and PC underutilization. We plan to develop interventions to increase PC referral rates and reduce visit delays among our vulnerable safety-net patient population.