Abstract PS4-09-23: Palliative Care Utilization and Associated Outcomes in Hospitalized Breast Cancer Patients: Using The National Inpatient Sample 2021

Abstract Background: While palliative care (PC) is increasingly recognized as essential in oncologic care, its utilizationamong breast cancer patients remains underexplored at a national level. We examined predictorsand outcomes associated with inpatient PC use in breast cancer hospitalizations. Methods: We conducted a retrospective cross-sectional analysis using the National Inpatient Sample (NIS)2021. Adult hospitalizations with a diagnosis of breast cancer and Palliative encounter wereincluded using the appropriate ICD-10 codes. Survey-weighted logistic and linear regressionmodels were employed to assess factors associated with PC utilization and its impact on inpatientmortality, length of stay (LOS), and total hospitalization charges. Covariates includeddemographics, comorbidities (Charlson Index), income quartile, insurance type, hospital teachingstatus, region, and bed size. Results: Among 32,719 breast cancer hospitalizations, PC was utilized in 12.1% (95% CI: 11.6–12.6%).Patients receiving PC were older (mean age: 66.8 vs. 65.1 years, p < 0.001), had higher comorbidityburden, and were more frequently treated at teaching hospitals (p < 0.001). White patients wereslightly more likely to receive PC compared to Black and Hispanic patients. Insurance status was astrong predictor (p < 0.001), with higher PC utilization observed among Medicaid and Medicarerecipients compared to those with private insurance. Additionally, patients treated at teachinghospitals and larger hospitals were more likely to receive PC, with both hospital teaching status (p <0.001) and bed size (p = 0.016) showing significant associations.Adjusted analysis showed that PC was independently associated with higher odds of in-hospitalmortality (aOR: 13.36, 95% CI: 11.91–14.99, p < 0.001), longer LOS (adjusted mean difference:+1.83 days, 95% CI: 1.55–2.12, p < 0.001), and increased total charges (adjusted mean difference: +$9,614, 95% CI: $5,163–$14,066, p < 0.001). Disparities were observed across racial andsocioeconomic strata, with patients from higher income quartiles and teaching hospitals more likelyto receive PC. Conclusions: Palliative care was used in 12.1% of breast cancer hospitalizations, with notable disparities by race,insurance, and hospital characteristics. Utilization was higher among older patients, those withMedicaid/Medicare, and at teaching hospitals. PC was associated with higher in-hospital mortality,longer stays, and increased charges. These patterns suggest appropriate use in severe illness but alsoreflect access gaps. Efforts are needed to promote equitable palliative care delivery across allsettings. Citation Format: S. Rajarajan, K. Babu, M. Jin, G. Gorecki, R. Dileo, S. Arivazhagan, Y. Khalid, C. Hilton. Palliative Care Utilization and Associated Outcomes in Hospitalized Breast Cancer Patients: Using The National Inpatient Sample 2021 [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-09-23.