EOLP-07. Sociodemographic and clinical determinants of palliative care utilization in glioblastoma

BACKGROUND Glioblastoma (GBM) is an aggressive primary brain tumor with poor survival and high symptom burden. However, real-world data on utilization trends and disparities in access to palliative care (PC) remain limited at the national level. METHODS A retrospective analysis was conducted on GBM cases from the National Cancer Database (2004-2021). Multivariable logistic regression was used to evaluate factors associated with receipt of PC. Covariates included age, sex, race, ethnicity, insurance status, income, education, urban/rural residence, distance to facility, Charlson Comorbidity Index (CCI), tumor location, histology, and year of diagnosis. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. RESULTS A total of 149,914 GBM patients were included. High PC utilization was more prevalent among patients aged ≥65 (aOR 1.31, 95% CI 1.12-1.54), females (aOR 1.12, 95% CI 1.06-1.17), those with public insurance (aOR 1.44, 95% CI 1.33-1.55), income <$46,276 (aOR 1.32, 95% CI 1.19-1.46), non-Hispanic ethnicity (aOR 1.52, 95% CI 1.33-1.76), greater comorbidity burden (CCI 2-3 vs. 0: aOR 1.50, 95% CI 1.40-1.61), and non-metropolitan residence (aOR 1.28, 95% CI 1.19-1.39). Low PC utilization was associated with non-White race (aOR 0.90, 95% CI 0.82-0.98) and living >50 miles from the reporting facility (aOR 0.56, 95% CI 0.51-0.62). Gliosarcoma histology was linked with lower use (aOR 0.56, 95% CI 0.44-0.71), while tumors in ventricular locations were associated to higher use (aOR 2.26, 95% CI 1.59-3.11). PC utilization increased over time, with higher odds in 2018-2021 compared to 2004-2008 (aOR 1.41, 95% CI 1.32-1.52). CONCLUSIONS Despite its importance, PC remains underutilized in GBM. Use varies by sociodemographic and clinical factors, with persistent disparities by race, income, insurance, geography, and tumor subtype. These findings call for targeted efforts to ensure equitable integration of supportive care in GBM management.