665 Background: Pancreatic cancer is characterized by high symptom burden, rapid progression, and poor prognosis. ASCO guidelines recommend palliative care consultation at diagnosis or within 8–12 weeks. However, access to timely and comprehensive care remains limited, particularly for patients in rural areas. This study evaluates disparities in the timing of palliative and hospice referrals among veterans with pancreatic cancer. Methods: A retrospective chart review was conducted of 118 patients diagnosed with pancreatic cancer at the Memphis VA Medical Center between 2014 and 2024. Variables collected included race, travel time to the VA, timing of palliative care and hospice referrals, and overall survival (OS). Rural status was defined as a travel time >1 hour from the facility. Descriptive statistics and logistic regression were used to evaluate associations. Results: Among 118 patients, 57% received a palliative care consultation and 40% were referred to hospice. The cohort was 66% urban and 34% rural. The mean time from diagnosis to palliative care was 155 days (median 38; IQR 11.5–203), with 48% of consults occurring beyond six weeks. Patients receiving palliative care had a mean OS of 532 days (median 245), compared to 486 days (median 198) in those who did not (p = 0.72). Rural patients experienced longer delays to both palliative care (+74 days) and hospice referral (+226 days) compared to urban patients (p = 0.1 for both). Mean OS was 572 days for rural vs. 481 days for urban patients (difference: 91 days; odds of death: 1.29; p = 0.95). Racial disparities were also observed. Black patients had a 67-day longer delay to hospice referral compared to white patients (p = 0.4). Median time to palliative care was similar (162 vs. 166 days; p = 0.8). Black patients had lower odds of receiving palliative care (OR 0.78; p = 0.53) and hospice referral (OR 0.70; p = 0.36). Conclusions: Despite guideline recommendations, many patients with pancreatic cancer did not receive timely palliative or hospice care. Delays were more pronounced among rural and Black patients, highlighting persistent disparities in access. These findings support the implementation of a quality improvement initiative at the Memphis VA to standardize early palliative care referrals for high-risk populations.
Blackmon et al. (Sat,) studied this question.