Utilization of Optimal End-of-Life Care for Acute Myeloid Leukemia Often Delayed

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Older patients with AML were more likely to underutilize intensive end-of-life care and enroll in hospice.
Older patients with AML were more likely to underutilize intensive end-of-life care and enroll in hospice.

Hospice services and effective health care strategies are underutilized by patients with acute myeloid leukemia (AML) leading to suboptimal end-of-life care, according to a report published in the Journal of Clinical Oncology.

The core measures of end-of-life care for patients with AML have been adequate hospice care and conservative use of intensive treatment as this population faces very poor prognoses, but studies show that patients often opt to do the opposite. 

Researchers used the Surveillance, Epidemiology, and End Results (SEER) Medicare linked database to track a population based cohort of 13,156 patients with AML.

They found that while hospice enrollment increased to 56.4% in 2012 from 31.3% in 1999, the primary cause of this increase was enrollment within the last 7 days of life. Among the 5847 patients who entered hospice care, 47.4% enrolled in the last 7 days of life and 28.8% enrolled in the last 3 days of life.

Sixty-two percent of patients who entered in and out hospice care received transfusions outside of hospice care, and patients who decided to receive chemotherapy within the last 14 days of life increased from 7.7% to 18.8% from 1999 to 2012.

The study also showed that nonwhite males were more likely to receive chemotherapy and underutilize hospice care, whereas older patients were more likely to underutilize intensive end-of-life care and enroll in hospice.

Current end-of-life care is suboptimal for patients with AML, and the authors conclude that “changes to current hospice services, such as enabling the provision of transfusion support, and improvements in physician-patient communications, may help facilitate better end-of-life care in this patient population.”

Reference

Wang R, Zeidan AM, Halene S, et al. Health care use by older adults with acute myeloid leukemia at the end of life [published online August 7, 2017]. J Clin Oncol. doi: 10.1200/JCO.2017.72.7149

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