Disparities in palliative care delivery for metastatic cancer patients: A nationwide analysis using the NIS 2020 dataset.

114 Background: Palliative care plays a vital role in supporting patients with advanced cancer by focusing on comfort, communication, and quality of life. Despite its proven benefits, it is often introduced late in the course of illness, or not at all. Factors such as race, insurance type, and hospital characteristics may influence access, but these patterns are not fully understood. By examining national data, this study aims to identify who receives palliative care and when, helping to uncover disparities and improve end-of-life care delivery. Methods: We conducted a retrospective cross-sectional analysis using the 2020 National Inpatient Sample (NIS). Adult patients with metastatic cancer were identified using ICD-10 codes C77–C80, and we defined palliative care with code Z515. To compare demographics, outcomes, and hospital factors, we utilized chi-square tests, t-tests, and logistic regression. Our analysis included survey-weighted models that adjusted for the sampling design. We also conducted subgroup and interaction analyses to investigate how race, insurance, age, and hospital characteristics influenced the results. All statistical analyses were done on R software (Version 4.5.0). Results: In this national analysis of 4,098 metastatic cancer patients, 25.5% (n = 1,044) received palliative care. Compared to non-recipients (n = 3,054), those receiving palliative care had higher in-hospital mortality (31.3% vs. 8.7%, p < 0.001), longer mean length of stay (8.91 ± 8.13 vs. 7.97 ± 8.57 days, p = 0.002), and comparable hospital charges (mean $119,029 vs. $116,440, p = 0.685). Logistic regression showed “No charge” insurance was associated with increased odds of palliative care (OR = 3.82, p = 0.049), while self-pay status approached significance (OR = 1.48, p = 0.073). Race, age, and female sex were not statistically significant predictors (p > 0.1). Survey-weighted models confirmed these findings. Interaction modeling showed no significant race–insurance interaction effect (p = 0.285). Teaching hospital status was significantly associated with increased palliative care delivery (OR = 1.17, p = 0.043). In patients aged ≥65 years (n = 1,988), no variables reached significance, though teaching hospitals again trended toward higher palliative use (p = 0.064). Proportional analysis revealed disparities in palliative care use across racial and insurance groups, despite adjustment. Conclusions: Palliative care was poorly accessed by patients with metastatic cancer, frequently initiated late despite high mortality. Insurance type, teaching hospital status, but not race or sex, influenced access. These results highlight system-level hurdles, and suggest the need for policies to facilitate the earlier integration of palliative care throughout all hospital environments.