Social determinants of health factors and palliative care services use among patients with metastatic breast cancer in Florida

1102 Background: ASCO recommends palliative care (PC) as an adjunct to the oncologic standard of care for patients with metastatic cancer. However, current evidence on PC utilization in patients with breast cancer and its relationship with area-level social determinants of health (SDoH) factors is limited. Therefore, we examined the associations between county-level factors and PC utilization among patients with metastatic breast cancer (mBC) in Florida. Methods: We extracted patient-level data (n = 23,539 patients diagnosed with mBC between 2012 and 2021) from the OneFlorida+ Data Trust and linked it to county-level data (67 Florida counties) from the AHRQ-SDoH Database. PC utilization since cancer diagnosis was identified using ICD-9 code V66.7 or ICD-10 code Z51.5. We assessed differences in PC utilization with county-level SDoH factors (e.g., poverty rate, transportation resource, provider supply, racial segregation) using bivariate analysis. Multivariable Poisson regression, including significant factors from bivariate analysis, was used to compare the PC utilization for the SDoH factors. Results: Our study population's overall prevalence of PC utilization was 16.1%. PC utilization was higher for patients with mBC residing in counties with a higher proportion of residents living in poverty and with a greater supply of advanced practice providers (APP: NP, PA), general surgeons, and nursing homes. Patients with mBC in counties with higher proportions of residents who identified as immigrants, with limited English proficiency, without personal transportation, and having higher racial segregation had lower PC utilization. In adjusted analysis, the supply of APP (coefficient:0.12) and nursing homes (coefficient:0.09) was associated with increased PC utilization. Conversely, racial segregation (White vs. non-White) was associated with decreased PC utilization (coefficient: -0.07). Conclusions: PC utilization among patients with mBC was associated with several SDoH at the county level. Notably, low PC utilization was associated with racial residential segregation and fewer APPs and nursing homes. Further research is needed to identify mediators in these relationships to improve PC effectiveness for patients with mBC in Florida.