Among patients who were hospitalized at the end of life, early palliative care (PC) consultation was significantly lower for those with hematological malignancies than for those with other malignancies. Also, racial, socioeconomic, and hospital resource-related factors were associated with lower odds of receiving PC services, according to the results of a study presented at the virtual 2021 Lymphoma, Leukemia & Myeloma (LL&M) Congress.

The investigators conducted a retrospective study leveraging data from the National Inpatient Sample (NIS) database. The study population included adult patients who had been hospitalized for ≥3 days and passed away during that hospitalization between 2016-2018. Patients with hematological malignancies, other malignancies, comorbidities, PC encounters, and procedures were distinguished based on International Classification of Diseases (10th Revision) codes.

The primary outcome was PC consultation. The investigators also used multivariate analysis to determine factors associated with PC services at the end of life. 


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Of 404,011 patients, 254,431 had passed away at ≥3 days of hospitalization. There were 13,083 patients with hematological malignancies (myeloma, n=2424; lymphoma, n=5009; lymphoid leukemia, n=2,010; myeloid leukemia, n=2,807; and other leukemia, n=833), 59,420 patients with non-hematological malignancies, and 181,394 patients without cancer.

Among all patients who passed away at ≥3 days of hospitalization, the PC consultation rate was 48.8% (noncancer, 46.2%; myeloma, 51.0%; lymphoma, 51.6%; lymphoid leukemia, 49.6%; myeloid leukemia, 54.2%; other leukemia, 47.7%; and nonhematological malignancies; 55.9%).

Patients with hematological malignancies and noncancer conditions had significantly lower odds of PC consultation than patients with non-hematological malignancies (PC consultation adjusted odds ratio [aOR]: multiple myeloma aOR, 0.83, P <.0001; lymphoma aOR, 0.81, P <.0001; lymphoid leukemia aOR, 0.76, P <.0001; myeloid leukemia aOR, 0.90, P <.01; other leukemia aOR, 0.70, P <.0001; noncancer aOR, 0.70, P <.0001). Among patients with different hematological malignancies, odds of PC consultation were comparable.

The investigators identified a number of other factors independently associated with increased odds of receiving PC consultation, including advanced age (vs <40 years aOR ranged from 1.21 for age 40-49 years to 1.54 for >60 years), female (vs male aOR, 1.19), Medicaid (vs Medicare aOR, 1.06), private insurance (vs Medicare aOR, 1.28), self-pay (vs Medicare, 1.20), higher income (vs 1st quartile aOR ranged from 1.13 for 2nd quartile to 1.42 for 4th quartile), admission in hospitals with medium or large size (vs small aOR, 1.12 and 1.34), teaching hospital (vs nonteaching aOR, 1.41), located in urban area (vs rural aOR, 1.07), located in the Midwest and West (vs Northeast aOR, 1.29 and 1.28), and study year of 2017 and 2018 (vs 2016 aOR, 1.12 and 1.22).

They also identified a number of other factors independently associated with lower odds of receiving PC consultation, including African American (vs Caucasian aOR, 0.68), Hispanic (0.74), Asian or Pacific Islander race (0.81), other race (0.70), and located in South (vs Northeast aOR, 0.96).

“Additional systemic interventions and investigations are required to improve the disparities of PC [consultation] in patients with hematological malignancies,” the investigators concluded.

Reference

Hsieh T, Yeo YH, Zou G, Famiglietti J. Racial, socioeconomic, and hospital resource related factors were associated with low palliative care utilization in end-of-life hospitalized patients with hematological malignancies: insights from the National Inpatient Sample database analysis. Poster presented at: 2021 Lymphoma, Leukemia & Myeloma Congress; October 19-23, 2021. Presentation PO-35.

This article originally appeared on Hematology Advisor