EOLP-02 - Effect of health disparities on end of life care in glioblastoma, IDH wildtype (GBM) patients

GBM is the most common malignant brain tumor in adults. Given the highly aggressive course and rapid neurologic decline, end of life care is critical. Proactive referral to hospice care is associated with improved quality of life and is recommended under current oncology guidelines. Utilization of these services is limited, with hospice referral rates ranging from 60-75%. The role of healthcare disparities upon quality of end of life care remains unclear. The goal of this study was to investigate the influence of healthcare disparities upon hospice service utilization by comparing patients at Ben Taub (BT), a Houston public safety net hospital, to Baylor St. Luke’s (BSL), a private academic institution. 50 patients (16 BT, 34 BSL) diagnosed with GBM, IDH wildtype, since 2016 were analyzed via retrospective chart review. Patient demographics and insurance status varied, with BT patients more likely to be Hispanic or African American (BT 94%, BSL 29%) and to be uninsured or insured via the county financial aid program (BT 88%, BSL 6%). Hospice referral rates were overall consistent with prior studies (BT 75%, BSL 68%). BT patients were referred to hospice later (BT 3.8, BSL 5.5 weeks mean survival after referral, p=0.118) and were more likely to be referred while in an inpatient setting (BT 75%, BSL 36%, p=0.07). Additionally, BT patients were more likely to be admitted to the hospital in the month prior to death (BT 44%, BSL 33%, p=0.537) and to die in an inpatient setting (BT 19%, BSL 3%, p=0.096). These findings call attention to the impact of healthcare disparities upon utilization of end of life services. Further research is needed to investigate factors contributing to these discrepancies and implement tools to improve quality of life in all patients with late-stage GBM regardless of race, socioeconomic, or insurance status.