Patterns and timing of palliative care consultation in patients with newly diagnosed metastatic cancer.

12064 Background: Early integration of palliative care (PC) improves symptom burden, quality of life, and healthcare utilization in advanced cancer, yet referrals frequently occur late in the disease course. We evaluated institutional patterns of PC utilization to quantify consultation rates, timing, and demographic predictors of referral among patients with newly documented metastatic disease. Methods: We conducted a retrospective cohort study of adults with newly documented metastatic disease identified using ICD-10 secondary lymph node metastasis codes (C77.x) who received oncology care at the Mitchell Cancer Institute between November 2024 and November 2025. The first metastatic code defined time of diagnosis. Outcomes included PC consultation rate, time from diagnosis to consultation, consultation setting, and timing relative to death. Multivariable logistic regression evaluated associations between age, sex, insurance status, and race with receipt of consultation. Results: Among 375 patients (median age 66 years, IQR 56–74), 64 (17.1%) received a PC consultation. Consultation rates varied more than fourfold across primary diagnoses (6%–29%). Among patients with post-diagnosis consultations, the median time to consultation was 66 days (IQR 25–130), with more than half occurring >60 days after diagnosis. Most consultations occurred in the outpatient cancer center (78%). Among decedents who received consultation, 64% were first seen within 90 days of death, consistent with late referral. In multivariable analysis, increasing age was associated with a lower likelihood of consultation (OR 0.97 per year, 95% CI 0.95–0.99, p=0.016), while Black patients had higher odds of consultation compared with White patients (OR 1.82, 95% CI 1.02–3.25, p=0.044). Sex and insurance status were not independently associated with referral. Conclusions: PC utilization was low, highly variable, and frequently delayed among patients with metastatic cancer. Although most referrals originated in the outpatient setting, many occurred near the end of life. Diagnosis-triggered referral pathways may promote earlier and more equitable integration of supportive oncology services. Palliative care utilization and predictors of consultation. Characteristic Value Total patients 375 Median age, years (IQR) 66 (56–74) Received PC consultation 64 (17.1%) Median time diagnosis → consultation, days (IQR) 66 (25–130) Initial outpatient consultation 78% Consultation ≤90 days before death (decedents) 64% Black vs White race, adjusted OR 1.82 (p=0.044) Age (per year), adjusted OR 0.97 (p=0.016) Most referrals occurred late in the disease course >50% after 60 days PC = palliative care; IQR = interquartile range; OR = odds ratio. Timing calculated among post-diagnosis consultations. Odds ratios from multivariable logistic regression.