Disparities in palliative care receipt among young adults newly diagnosed with poor-prognosis cancers.

320 Background: Young adults with advanced cancer face unique psychosocial challenges and supportive care needs. National oncology guidelines recommend early specialty palliative care (PC), typically outpatient and provided concurrently with systemic treatment. This study aims to examine the receipt of any PC and systemic treatment among young adults newly diagnosed with poor-prognosis cancer. Methods: Using the National Cancer Database, we identified patients aged 18-39 years newly diagnosed with stage-IV cancers or poor-prognosis brain tumors between 2010-2022. Safety-net hospital status was classified by the percentage of uninsured and Medicaid patients treated at the treating facility. Outcomes included receipt of any palliative care (e.g., pain management) excluding palliative-intent systemic therapy, and any systemic treatment in the first course of treatment. Multivariable logistic regression was used to examine associations of individual-level and facility-level characteristics with each study outcome, adjusting for year of diagnosis and state. Results: A total of 72,387 patients were included, with 66,473 patients with stage-IV cancers and 5,914 patients with high-grade brain tumors. The percentage receiving any PC increased from 2.1% in 2010 to 4.1% in 2022. Use of systemic therapy also increased from 83.2% to 88.4%. Patients with pancreas (8.0%), lung (6.4%), and stomach (6.1%) cancers had the highest PC receipt rates. In adjusted models, Uninsured or with Medicaid were more likely to receive PC (Adjusted Odds Ratio (AOR) 1.63, 95% CI: 1.39-1.90; AOR 1.64, 95% CI 1.48-1.81) but less likely to receive concurrent systemic treatment (AOR 0.65, 95% CI 0.60-0.70; AOR 0.84, 95% CI 0.79-0.88) than privately insured patients. Compared to patients treated at hospitals with the lowest proportion of uninsured/Medicaid patients (0-6.26%), patients treated at safety-net hospitals (12.47-85.50% uninsured/Medicaid) were more likely to receive PC (AOR 1.34; 95% CI: 1.16-1.54) but less likely to receive systemic therapy (AOR 0.85; 95% CI: 0.79-0.91). Patients treated at NCI-designated cancer centers were more likely to receive both PC (AOR 1.23; 95% CI: 1.09-1.40) and systemic therapy (AOR 1.61; 95% CI: 1.50-1.72) compared to community cancer programs. Conclusions: Although PC use has increased over time among young adults with advanced cancers, utilization remains low, highlighting potential unmet needs for symptom management. Insurance coverage and treating facility characteristics were associated with PC receipt and concurrent systemic treatment, underscoring the contribution of potentially modifiable institutional practices and other health care factors. Our findings emphasize the need for targeted policies to ensure timely PC and comprehensive cancer care for this young, vulnerable population, especially with increasing prevalence of early-onset cancers.