Patterns and disparities in palliative care utilization and aggressive inpatient care at the end-of-life among hospitalized patients with metastatic lung cancer.

107 Background: Early palliative care (PC) improves outcomes in lung cancer, but inpatient delivery and timing remain inconsistent. Simultaneously, aggressive interventions; like ICU admission, chemotherapy, and invasive procedures, are frequently used during hospitalizations. This study describes patterns of inpatient PC use and aggressive care delivery in stage IV lung cancer patients, with a focus on terminal hospitalizations. Methods: A retrospective analysis was conducted using the National Inpatient Sample (NIS) database from 2016 to 2020. Aggressive inpatient care was defined as ICU-level care (mechanical ventilation, vasopressors, etc), chemotherapy, radiation therapy, or invasive procedures. Multivariable and multinomial logistic regression was used to identify sociodemographic and hospital-level factors associated with aggressive care and PC utilization. Results: Among 171,922 hospitalizations, 6.7% (n = 11,556) involved ICU care, 2.8% (n = 4,745) received chemotherapy, 11.6% (n = 20,029) had invasive procedures, and 24.1% (n = 41,381) included PC. Of 19,605 terminal hospitalizations, 63.9% had PC encounters. Overall, ICU care was more common in Black (OR 1.36) and Asian/Pacific Islander patients (OR 1.26), and less common in females (OR 0.85) and older patients (OR 0.99)(all p < 0.001). Invasive procedures were more frequent in Asian/Pacific Islanders (OR 1.41) and less so in Black patients (OR 0.90) ( p < 0.001). PC use was associated with older age (OR 1.01), urban teaching hospitals (OR 1.45), and receipt of aggressive interventions ( p < 0.001). No racial disparities were observed in overall PC use. ICU care increased total hospital charges by $57,388 ( p < 0.001), while PC (-$9,201, p < 0.001) and radiation therapy (-$3,996, p < 0.013) were associated with lower costs. ICU care raised the risk of discharge to short-term facilities (RRR 5.8) versus PC (RRR 1.83) ( p < 0.001). Patients receiving PC were more likely to be discharged home with supportive services (RRR 5.31 vs. 2.40 for ICU care p < 0.001). In-hospital death was more likely with ICU care (RRR 46.52) than PC (RRR 26.85) ( p < 0.001). In terminal hospitalizations, ICU care (OR 16.18) and PC (OR 7.44) were common ( p < 0.001). Black patients had lower odds of terminal hospitalization (OR 0.91), while Asian patients had higher odds (OR 1.23) ( p < 0.001). Female patients had decreased odds (OR 0.87, p < 0.001). Notably, in the terminal subgroup, African American patients were less likely to receive PC (OR 0.67, p < 0.001). Conclusions: Aggressive care is frequently used, even among patients receiving PC. While overall PC access appears equitable, sociodemographic disparities persist at the end of life. These findings underscore the need for early PC integration and targeted efforts to improve equity in terminal care.