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Scientific Oral Presentations

Head and Neck Surgery

Session: Scientific Presentation 5 - Head and Neck Surgery

Palliative Care Usage and Outcomes Among Patients with Advanced Head and Neck Cancer

Monday, October 13, 2025
1:54 PM - 2:00 PM EDT
Location: 127
Disclosure(s):
Andrew V. Meci, MPH:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Pallavi P. Kulkarni, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Emily N. Milarachi, MD, MSCI:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The American Society of Clinical Oncology (ASCO) strongly recommends that patients with advanced solid tumors are referred for interdisciplinary palliative care (PC), which focuses on optimizing the quality of life for patients during cancer treatment. We conducted a large database analysis to characterize utilization and outcomes of advanced head and neck cancer (HNC) patients accessing PC.

Methods: We conducted a retrospective cohort analysis using the TriNetX research database. Patients aged ≥18 years with stage 3 or 4 HNC from 2009-2019 receiving at least one encounter for PC were included. Primary outcomes were five-year overall survival and rates of life-sustaining measures compared to a demographic and comorbidity-matched control cohort. Secondary outcomes included rates of mental health diagnoses, health system interactions, treatment patterns, and outcomes among patients undergoing surgery.

Results: Of 12,522 patients with advanced HNC (80% S4 and 20% S3), 7.4% (n=923) received PC within five years. After matching, there were 837 patients with advanced HNC with 2.8 mean PC encounters and 344.9 mean days from diagnosis to PC. Five-year survival probability in the PC cohort was 23.4% compared to 62.4% in the control cohort (p < 0.01). Receiving PC showed no significant differences in life-sustaining measure use (p=0.69) or mental health diagnoses (p=0.74). The PC cohort had an increased risk for health system encounters (p < 0.01), despite decreased rates of oncologic treatment (p < 0.01). Surgical patients receiving PC had similar gaps in overall survival despite no difference rates of life sustaining treatment.

Conclusions: Less than 10% of all advanced stage HNC are seen by PC. Thus, involvement of PC is underutilized despite current guidelines. Our results suggest that PC was likely limited to those with the most unfavorable prognoses. Prospective research may help to elucidate the benefits of PC, particularly when utilized both broadly and earlier following HNC diagnosis. This study highlights an important opportunity for growth in multi-disciplinary HNC patient care.

    Presenting Author(s)

  • Andrew V. Meci, MPH

    Medical Student
    Penn State College of Medicine
    Hershey, Pennsylvania, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • PK

    Pallavi P. Kulkarni, MD

    Resident
    Penn State Health/Milton S. Hershey Medical Center
    Hummelstown, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Emily N. Milarachi, MD, MSCI

    Resident, PGY 4
    Penn State Health Hershey Medical Center
    Hershey, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Emily K. Funk, MD

    Assistant Professor of Otolaryngology-Head & Neck Surgery
    Penn State Milton S Hershey Medical Center
    Hershey, PA, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • NG

    Neerav Goyal, MD MPH FACS

    Professor; Division Chief Head and Neck Surgery; Vice Chair Patient Safety and Quality
    Penn State Milton S Hershey Medical Center
    Hershey, Pennsylvania, United States

    Disclosure information not submitted.