Palliative care utilization in patients with <i>EGFR</i> -mutant metastatic non-small cell lung cancer receiving first-line <i>EGFR</i> TKIs.

Abstract

e24076 Background: Patients with metastatic EGFR -mutant NSCLC experience prolonged survival with EGFR tyrosine kinase inhibitors (TKIs), particularly in the osimertinib era. Despite extended disease trajectories, the timing and frequency of palliative care (PC) involvement in this population remain poorly characterized. In contrast to chemotherapy-treated NSCLC cohorts, where early PC integration is common, patients receiving oral targeted therapy may experience delayed or absent PC referral due to perceived clinical stability. We evaluated patterns of palliative care utilization and associated clinical characteristics in a real-world EGFR TKI cohort at a single academic institution. Methods: We conducted a retrospective cohort study of 112 patients with EGFR -mutant metastatic NSCLC who initiated first-line EGFR tyrosine kinase inhibitor (TKI) therapy at Northwell Health between 2012 and 2025. Primary outcome was receipt of a formal palliative care consultation. Secondary outcomes included timing of referral relative to treatment initiation and death. Logistic regression was used to identify factors associated with palliative care referral, adjusting for age (≥75 vs &lt; 75 years), ECOG performance status (0-1 vs ≥2), baseline brain metastases, and first-line EGFR TKI. Results: Among 112 patients (median age 72), only 28 patients (25%) received palliative care referrals. Referral was more common among patients aged ≥75 years (54% vs 31%, p = 0.035). In multivariable analysis, age ≥75 remained independently associated with referral (OR 2.68, 95% CI 1.04-7.10, p = 0.04), while ECOG ≥2 (p = 0.52), brain metastases (p = 0.54), and TKI choice (p = 0.46) were not significant predictors. Median time to referral was 70.9 weeks (IQR 13.2-99.6) after first-line TKI initiation. Nine of 28 referrals (32%) occurred after second-line therapy initiation. Among 28 deceased patients, 15 (53.5%) received referral within 90 days of death. Even among 30 patients achieving ≥3 years survival, 24 (80%) never received palliative care referral and referral rates remained low across age groups ( &lt; 75 years: 13.6%; ≥75 years: 37.5%) and brain metastasis status (absent: 17%; present: 28.6%). Conclusions: Palliative care referral in EGFR -mutant metastatic NSCLC was infrequent and often occurred late in the disease course, with referral patterns more strongly associated with age than functional status. Most referrals occurred near the end of life rather than earlier in the treatment trajectory. These findings suggest a potential care-delivery gap among patients treated with oral targeted therapies and indicate that existing models of early palliative care integration, largely developed in chemotherapy-treated populations, may not be consistently applied in this long-surviving group.