Access to palliative care in hospitalized lung cancer patients with malignant pleural effusions.

121 Background: Malignant pleural effusion (MPE) is a common and serious complication of advanced lung cancer (LC), often signaling poor prognosis and limited survival. Given its association with significant symptom burden and reduced quality of life, MPE frequently warrants timely palliative care involvement. This study examines demographic and institutional factors associated with palliative care use in hospitalized patients with LC and MPE. Methods: We performed a retrospective cross-sectional analysis using data from the National Inpatient Sample (NIS) between 2016 and 2020. Adult patients hospitalized with a primary diagnosis of lung cancer and a concurrent diagnosis of malignant pleural effusion were identified using ICD-10 codes. The primary outcome was receipt of inpatient palliative care services. Patient- and hospital-level characteristics were compared using chi-square and independent-sample t-tests. To identify independent predictors of palliative care utilization, we applied multivariable logistic regression, adjusting for age, sex, race, Charlson Comorbidity Index, insurance type, hospital region, urban or rural setting, teaching status, and median household income by ZIP code. Statistical analyses were conducted using a significance threshold of p < 0.05. Results: Among 211,535 hospitalized patients with LC and MPE, 52,410 (24.7%) received palliative care. Each one-year increase in age was associated with a 1.2% increase in the odds of receiving palliative care (aOR 1.012, p < 0.001). For every 1-point increase in the Charlson Comorbidity Index, the odds of receiving palliative care increased by 7.7% (aOR 1.077, p < 0.001). Compared to White patients, Asian patients had significantly lower odds of palliative care use (aOR 0.88, p < 0.001). Treatment in teaching hospitals was associated with higher odds of palliative care use compared to non-teaching hospitals (aOR 1.20, p < 0.001). Regional variation was observed, with higher odds of palliative care use in the Midwest (aOR 1.18), South (aOR 1.12), and West (aOR 1.21) compared to the Northeast (all p < 0.001). Compared to privately insured patients, those with Medicare had lower odds (aOR 0.88, p < 0.001), while self-pay patients had higher odds of receiving palliative care (aOR 1.32, p = 0.002). Conclusions: Significant disparities exist in palliative care utilization among hospitalized patients with lung cancer and MPE. Use of palliative services is influenced by age, comorbidity burden, race, insurance status, hospital type, and geographic region. These findings highlight the need for equitable access to palliative care across diverse patient populations.