Background: There is increasing recognition of the importance of supportive care for cancer patients at the end of life. This includes palliative care consultation, home health nursing, and hospice. However, the prevalence in use of supportive care services for younger patients has not been previously described. We also examined whether ASCO’s 2012 Choosing Wisely campaign to reduce overuse of aggressive end-of-life care resulted in increased supportive care services use. Methods: Claims data from the HealthCore Integrated Research Database were analyzed, which includes ~60 million individuals enrolled in Blue Cross and/or Blue Shield licensed plans across 14 states. Patients aged ≤65 who died between 2007-2014 and who had diagnoses for metastatic lung, colorectal, breast, pancreatic, and prostate cancers were included. Poisson multivariable regression models assessed associations between age group, geographic region, gender, and regional education and income measures with supportive care use. Results: 28,731 patients were included. Overall, 39-42% of patients across cancers received supportive care services within the last 90 days of life (Table), including 15-19% of patients enrolled in hospice. Supportive care use increased for patients with lung (by 4%), colorectal (2%), breast (2%), and prostate (22%) cancers comparing early 2012 before Choosing Wisely to 2014; but decreased (5%) in pancreatic cancer. In addition, 53-55% of patients were prescribed medications for pain, anxiety, nausea, anorexia, depression, or delirium. Multivariable models showed regional variations in use of supportive care. Conclusions: Use of supportive care services for younger patients at the end of life increased modestly for several common cancers after the 2012 ASCO Choosing Wisely recommendations. However, there remains substantial underuse of hospice, home health nursing, and palliative care consultation among these patients.