(125) Social Determinants of Health and Palliative Care Outcomes in Head and Neck Cancer

Introduction: Social determinants of health (SDoH) are associated with disparities in cancer outcomes, but their impact among head and neck cancer (HNC) patients receiving palliative care (PC) is understudied. We examined associations between SDoH, early symptom burden, and healthcare utilization in HNC patients receiving PC.

Methods: This retrospective cohort study was conducted using TriNetX, including adults (≥18) with HNC from 2018–2026 and ≥1 prior clinical encounter. First, HNC patients with and without ≥1 documented SDoH flag (ICD-10-CM codes Z55-Z65: poverty, housing insecurity, food insecurity, unemployment, etc.) were 1:1 propensity-score matched (nearest-neighbor, caliper 0.10 SD) on age, sex, race, and ethnicity to compare PC utilization.

Second, among patients with ≥1 PC encounter post-HNC diagnosis (n=19,087), outcomes were compared between patients with SDoH (n=1,078) and matched patients without SDoH (n=1,078). Outcomes were assessed at 90 days, 6 months, 1 year, and 5 years.

Results: HNC patients with SDoH were more likely to use PC than non-SDoH patients (25.4% vs 10.1%, p< 0.001). Among patients who used PC, SDoH was associated with significantly higher healthcare utilization at 90 days: ED visits (33.4% vs 20.6%, p< 0.001), opioid prescriptions (11% vs 8.1%, p=0.019), advance care planning (ACP) (6.6% vs 4.6%, p=0.049), and PC encounters (38.9% vs 32.3%, p=0.001). At 6 months, failure to thrive (15.5% vs 11.2%, p=0.004) and ACP (8.8% vs 6.1%, p=0.018) were significantly higher in the SDoH cohort. Gastrostomy, new depression/anxiety, ICU admission, and mortality rates were similar at all time points.

Conclusions: Among HNC patients who receive PC, SDoH are associated with higher early symptom burden and acute healthcare utilization without significant differences in ICU use, new mental health diagnoses, or mortality. These findings suggest that early PC referral, coupled with targeted social support interventions, may be critical to mitigating disparities for socially vulnerable HNC patients.