Understanding palliative care gaps in young adult ovarian cancer: A population-based study of 37,880 hospitalizations.

5557 Background: Palliative care (PalC) improves both quality of life and survival compared to usual care. Despite this, significant implementation gaps persist due to delayed or absent utilization. This study examines the determinants, trends, clinical profiles, and outcomes of PalC among young women hospitalized with ovarian cancer. Methods: We identified ovarian cancer patients among young adults aged 18-45 years using the National Inpatient Sample (NIS) from 2016-2022. We first estimated the prevalence of PalC utilization and then developed a multivariable logistic regression model to estimate the association of demographic, clinical, and hospital-level variables with PalC use. The in-hospital mortality burden associated with PalC receipt was also estimated. Results: We found 37,880 ovarian cancer young adults with 8.78% using PalC. Several variables were associated with PalC utilization. Clinical comorbidities demonstrated the strongest associations: metastatic cancer( aOR 4.123, 95% CI: 3.385-5.023, p<0.001), frailty (aOR 3.407, 95% CI: 2.803-4.142, p<0.001), and cachexia (aOR 3.817, 95% CI: 2.460-5.922, p<0.001). Depression was also significantly associated with PalC utilization (aOR 1.360, 95% CI: 1.056-1.751, p=0.017). Temporal trends revealed increasing PalC utilization in more recent years compared to 2016, with significantly higher odds in 2020 (aOR 1.412, 95% CI: 1.005-1.985, p=0.047) and 2021 (aOR 1.565, 95% CI: 1.122-2.184, p=0.008). Weekend admissions were associated with 38.2% higher odds of PalC receipt (aOR 1.382, 95% CI: 1.107-1.727, p=0.004), and each additional year of age increased odds by 1.5% (aOR 1.015, 95% CI: 1.001-1.029, p=0.034). Insurance status significantly influenced PalC receipt. Compared to Medicare beneficiaries, patients with private insurance had 36.6% lower odds of receiving PalC (aOR 0.634, 95% CI: 0.452-0.890, p=0.008), while self-pay patients had 51.1% lower odds (aOR 0.489, 95% CI: 0.293-0.816, p=0.006). Additionally, patients from the highest income quartile had 25.7% lower odds of PalC compared to those in the lowest income quartile (aOR 0.743, 95% CI: 0.555-0.996, p=0.047). Race, hospital location/teaching status, hospital region, and hospital bed size were not significantly associated with PalC receipt. The overall in-hospital mortality rate was 3.0%, with stark differences by PalC receipt: 21.5% among those receiving PalC versus 1.22% among those not receiving PalC (aOR 16.532, 95% CI: 11.205-24.389, p<0.001). Conclusions: Among hospitalized young adults with ovarian cancer, fewer than 1 in 10 received PalC. Services concentrated among patients with metastasis, frailty, and cachexia, suggesting late rather than early integration. Significant disparities by insurance and income highlight access barriers requiring intervention for equitable PalC integration into comprehensive cancer care.