End-of-life Care Intensity for Patients With MDS May Be Suboptimal

The intensity of end-of-life (EOL) care for patients with myelodysplastic syndromes may be optimal in terms of hospice use, a study published in the journal Cancer has shown.1

The prevalence of MDS will increase as the population ages, and many of those with MDS will require EOL care; however, there are limited data on the intensity of EOL care received by patients with these types of malignancies.

For the study, researchers analyzed data from 6955 patients with MDS who were included in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. They also evaluated the prevalence of predictors of intensive care unit (ICU) in the last month of life, chemotherapy in the last 2 weeks of life, and hospice enrollment of patients who died between 2006 and 2011.

Results showed that 7% of patients received chemotherapy and 28% were admitted to the ICU near the EOL. Nearly half of all patients enrolled in hospice.

Researchers found that patients dependent on red blood cell or platelet transfusions at the EOL (OR, 0.69; 95% CI: 0.61-0.78) and nonwhite patients (OR, 0.77; 95% CI: 0.67-0.89) were less likely to enroll in hospice than their counterparts.

The study also demonstrated that nonwhite patients were more likely to be admitted to the ICU near the EOL (OR, 1.19; 95% CI: 1.03-1.38).

“The lower odds of enrollment for transfusion-dependent patients suggest that the current hospice model, which largely disallows transfusions, may not be meeting the palliative needs of this population,” the authors conclude.

REFERENCE

1. Fletcher SA, Cronin AM, Zeidan AM, et al. Intensity of end-of-life care for patients with myelodysplastic syndromes: Findings from a large national database [published online ahead of print February 23, 2016]. Cancer. doi:10.1002/cncr.29913.

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