(A650) Underutilization of Palliative Care in Patients with Recurrent HNSCC Receiving Immunotherapy

Introduction: Palliative care (PC) is essential for symptom management and decision-making in recurrent head and neck squamous cell carcinoma (HNSCC), yet it remains underutilized, including after immunotherapy initiation. We examined factors associated with PC referral, as well as PC visit attendance and time to referral after starting immunotherapy.

Methods: We identified patients with recurrent HNSCC who received immunotherapy between 2018-2025 from our tertiary academic institution’s Head & Neck Registry. We summarized clinicodemographic characteristics and quality of life measures with descriptive statistics. Fisher’s exact/Chi-square tests were performed to compare categorical variables, and Mann-Whitney U tests were used for continuous variables for binary outcomes. For time to PC referral, we used Kruskal-Wallis or Mann-Whitney U tests for categorical predictors and Spearman’s correlation for continuous variables. Statistical analyses were conducted in R (version 4.4.1).

Results: Of 51 patients, 28 (55%) were referred to PC, and 21 (75%) attended a visit. The median time from immunotherapy initiation to PC referral was 93 days (IQR: 204). Patients referred to PC had significantly worse mood (p = 0.022) and lower social-emotional QOL (p = 0.027) before immunotherapy. Among referred patients, those treated in academic settings were more likely to attend a visit (p = 0.034). Older patients experienced longer delays before referral (p = 0.012, ρ = 0.475). Additionally, referral timing differed significantly by specialty (p = 0.012), with otolaryngology providers referring patients to PC earlier than other specialties.

Conclusions: Nearly half of patients did not receive a referral to PC, and referrals often occurred late in the treatment course. These findings underscore the need for more proactive and systematic PC integration for patients with recurrent HNSCC receiving immunotherapy.