Abstract B132: Access to palliative care for individuals with cancer experiencing homelessness

Abstract

Abstract Introduction Persons experiencing homelessness (PEH) face significant disparities in health outcomes and access to healthcare, including cancer-related and end-of-life care. PEH are less likely to receive age-appropriate cancer screening, more likely to be diagnosed with cancer at later stages, and more likely to die secondary to cancer compared to the general population. Qualitative research has demonstrated that PEH and the providers who care for them perceive gaps in access to palliative care, largely due to a lack of palliative care programs that cater to the specific needs of PEH. However, less is known about how medical providers’ referral patterns affect access to care. Providers may be less likely to refer PEH to palliative care services because of these known gaps in access, exacerbating existing disparities. The purpose of this study was to quantify the rates of palliative care referrals and outpatient palliative care visits along with time to initial palliative care referral and ambulatory palliative care visit. We hypothesized that PEH would be referred to palliative care at lower rates and have longer intervals to palliative care follow-up as compared to their housed counterparts. Methods A retrospective analysis was performed on patients with cancer admitted to an academic center’s medical oncology service between July 2022 and June 2023. Patients were stratified into two groups based on their housing status: housed and PEH. A comparative quantitative analysis was conducted between these groups. Results 1166 patients with cancer were admitted to the medical oncology service during the one-year study period. The mean age of the cohort was 61.0 years and 46.7% were female. Seventeen (1.4%) PEH and 1149 (98.6%) patients who were housed were identified. Among PEH, five (29.4%) were referred to ambulatory palliative care or received an inpatient consult to palliative care. Among patients who were housed, 362 (31.5%) were referred to ambulatory palliative care or received an inpatient consult to palliative care. Two (11.8%) PEH attended an ambulatory palliative care appointment compared to 183 (15.9%) patients who were housed. The mean number of days to first palliative care or hospice referral/consult was 25.5 in PEH and 43.9 in patients who were housed. The mean number of days to first ambulatory palliative care visit was 131 in PEH and 83.7 in patients who were housed. Conclusion The frequency of inpatient and ambulatory palliative care referrals was comparable between the two groups, suggesting that PEH are appropriately referred to palliative care. However, PEH had longer intervals from cancer diagnosis to first outpatient palliative care visit, suggesting that additional supports may be needed to ensure PEH can access outpatient follow-up. While this quantitative study is underpowered to detect statistically significant differences, it highlights a potential area for further study to develop interventions to better support PEH to achieve timely follow-up with ambulatory palliative care and hospice services after referral. Citation Format: Brandon A. Bellen, Katarina Leyba, Amanda V. Johnson, Eric Grimm, Erin Bredenberg. Access to palliative care for individuals with cancer experiencing homelessness [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B132.