Palliative care utilization in metastatic lung cancer at an urban safety-net hospital.

e20651 Background: Early integration of palliative care has been associated with improved survival, quality of life, and reduced healthcare costs among patients with metastatic lung cancer. ASCO and NCCN guidelines recommend early referral to interdisciplinary palliative care for patients with advanced lung cancer. Despite these recommendations, rates of early palliative care referrals remain low. Methods: We conducted a retrospective cohort analysis of patients diagnosed with metastatic lung cancer (SCLC and NSCLC) between January 1, 2021 and September 1, 2025 at an urban safety-net oncology clinic. Patients with non-small cell neuroendocrine tumors and those evaluated for a single clinic visit were excluded. Clinical and referral data, including diagnosis date, referral dates, outpatient encounters, and inpatient palliative care consultations, were obtained from the electronic medical record. Results: A total of 162 patients met inclusion criteria. Fewer than half of patients with advanced lung cancer (n=67, 41.3%) were referred to outpatient palliative care at any point during their disease course. Among those referred, 36 (53.7%) completed at least one outpatient palliative care visit. The mean time from stage IV diagnosis to outpatient palliative care referral was 136 days, with an additional mean interval of 59 days between referral order placement and first outpatient palliative care visit. Patients treated with oral targeted therapies (n=10) demonstrated a significantly longer time to palliative care referral compared with those receiving other treatment modalities (n=57) (mean 351 vs 99.2 days, mean difference 251.8, 95% CI 120.2 to 382.8; p = 0.0003). Inpatient palliative care utilization was common, with 91 of 162 patients (55%) receiving inpatient consultation; however, continuity after discharge was limited, with only 23% of these patients subsequently seen in outpatient palliative care clinic. Conclusions: Despite demonstrated survival benefits and guideline recommendations supporting early palliative care integration for patients with metastatic lung cancer, outpatient palliative care utilization remains low in this urban safety-net setting. Significant delays were observed throughout the referral pathway, including prolonged intervals from diagnosis to referral, delays between referral placement and initial outpatient visits, low rates of completed referrals, and missed opportunities to transition patients from inpatient to outpatient palliative care. Future implementation efforts should prioritize systematic, electronic medical record-based interventions such as automated referral triggers, standardized order sets, and care transition workflows to facilitate timely and equitable integration of outpatient palliative care to improve patient-centered outcomes. The impact of palliative care in patients receiving oral targeted therapy also requires further study.