Palliative care utilization in metastatic triple-negative breast cancer: A National Cancer Database analysis.

e24073 Background: Metastatic triple-negative breast cancer (TNBC) is associated with aggressive disease biology and poor prognosis compared to other breast cancer subtypes. Although palliative care (PC) has been shown to improve symptom burden and quality of life in advanced cancers, real-world utilization patterns of PC in metastatic TNBC remain poorly characterized. The aim of this study is to characterize patterns in PC utilization among patients with metastatic TNBC. Methods: The National Cancer Database was queried to identify patients diagnosed with metastatic TNBC between 2018 and 2023. PC was defined by NCDB as non-curative treatment, which includes surgery, radiation, systemic, pain management, or any combination. Multinomial logistic regression was used to evaluate associations between PC utilization and sociodemographic factors. Overall survival (OS) was estimated using Kaplan–Meier methods and compared using log-rank tests. Statistical significance was defined as p < 0.05. Results: A total of 9,212 patients with metastatic TNBC were identified. The mean age at diagnosis was 62.2 ± 14.6 years, and the median follow-up was 11.4 months (IQR 4.2–25.2). Overall, 1,799 (19.5%) patients received PC. Among those, the most common modality was systemic therapy (42.9%), followed by radiation therapy (22.8%), multimodal combinations (24.5%), pain management alone (5.6%), and surgery alone (4.2%) Insurance status was associated with PC use. Compared with privately insured patients, uninsured patients were more likely to use PC (OR 1.53, 95% CI 1.14–2.07, p = 0.005). Patients in Medicaid expansion states were also more likely to use PC than those in non-expansion states (OR 1.79, 95% CI 1.46–2.20, p < 0.0001). Facility-level and geographic variation was observed. Treatment at academic centers was associated with higher PC use compared with community cancer centers (OR 1.31, 95% CI 1.01–1.71, p = 0.041). Compared with patients treated in the West, those treated in the Northeast (OR 1.29, 95% CI 1.02–1.63, p = 0.037), Midwest (OR 1.27, 95% CI 1.00–1.61, p = 0.489), and South (OR 1.32, 95% CI 1.02–1.71, p = 0.038) were more likely to receive PC. Age, race, income quartile, educational level, and Charlson-Deyo comorbidity index were not independently associated with PC utilization. Conclusions: In this largest population-level study to date, we found that palliative care utilization remains low among patients with metastatic TNBC, and was associated with insurance coverage, facility type, and geographic region. These findings highlight disparities in access to PC, and underscore the need for more equitable and timely integration of PC among metastatic TNBC patients.