26 Background: Metastatic lung cancer patients are treated with palliative intent. Aggressive inpatient care at the end-of-life is seen as a marker of poor quality care. However, national trends and factors related to aggressive inpatient care at the end-of-life for these patients have not previously been evaluated. Methods: A total of 3,030,866 hospitalizations of metastatic lung cancer patients were identified in the National Inpatient Sample database between 1998 and 2014. Longitudinal analysis was conducted to determine trends in aggressive inpatient care at the end-of-life and multivariate logistic regression was performed to determine associations with age, race, region, and hospital characteristics. Results: From 1998 to 2014, in-hospital mortality for metastatic lung cancer patients decreased from 17% to 11%. However, the proportion admitted to the intensive care unit during the terminal hospitalization increased from 12.9% to 26.4%. Reflecting this aggressive end-of-life care, mean total charges for a terminal hospitalization increased from $29,386 to $72,469, adjusted for inflation. Among patients who died in the inpatient setting, the intensive care unit stay translated into higher total costs (+$18,461 CI: $17,460 to $19,463). Promisingly, palliative care encounters for terminal hospitalizations increased during this period from 8.7% to 53.0% and were correlated with a decrease in aggressive care at the end-of-life. A multivariable model showed variation by patient and hospital characteristics in aggressive inpatient care utilization. Conclusions: Among patients with metastatic lung cancer there has been a substantial increase in intensive care unit use during terminal hospitalizations, resulting in high cost for the health care system.