Utilization patterns and disparities in supportive oncology services for patients with stage IV non-small cell lung cancer.

Abstract

e20649 Background: Supportive oncology (SO) services, including palliative care, social work, and dietitian support, are essential components of comprehensive cancer care. Among patients with stage IV non-small cell lung cancer (NSCLC), early supportive oncology services involvement has been associated with improved quality of life, reduced aggressive end-of-life care, and improved survival. However, Canadian data characterizing SO service utilization is limited. The primary objective of this study was to evaluate the uptake of SO services among patients with stage IV NSCLC at a regional cancer centre. Secondary objectives included assessing disparities in SO utilization based on geographic location and access to a primary care provider (PCP). Methods: We conducted a retrospective cohort study of all patients diagnosed with stage IV NSCLC and seen at the Cancer Centre of Southeastern Ontario between January 2021 and April 2024. Demographic and disease characteristics and utilization of palliative care, social work, and dietitian services were collected. Modified Poisson regression with robust error variance was used to evaluate associations between SO uptake and rural versus urban residence, as well as the presence versus absence of a PCP. Results: A total of 647 patients were included (median age 70; 54.7% male). Adenocarcinoma was the most common histology (49.8%), followed by squamous carcinoma (19.9%). Sixty-four percent resided in rural areas, and 85.5% had a PCP. Uptake of palliative care, social work, and dietitian services was 56.7%, 29.5%, and 21.3%, respectively. Urban residence was associated with higher palliative care utilization (adjusted RR 1.27, p<0.001), with nonsignificant trends toward greater social work (RR 1.24, p=0.0821) and dietitian involvement (RR 1.33, p=0.069). Patients with a PCP were less likely to receive social work services (adjusted RR 0.69, p=0.014), with no significant differences in palliative care or dietitian use. Conclusions: SO service uptake among patients with stage IV NSCLC remains suboptimal, with notable geographic disparities disadvantaging rural populations. These findings highlight opportunities to expand equitable access to SO services across our cancer centre and nationwide.