The following article features coverage from the American Society of Hematology 2019 Annual Meeting. Click here to read more of Oncology Nurse Advisor‘s conference coverage.

Medicare patients with hematologic malignancies have increasingly made use of billed palliative care services (BPCS), according to a study presented at the 61st American Society of Hematology (ASH) Annual Meeting & Exposition, held in Orlando, Florida. However, this use has primarily been in the context of end-of-life (EOL) care, rather than occurring earlier in treatment.

The study investigators evaluated records from the Surveillance, Epidemiology, and End Results – Medicare database for patients with common hematologic malignancies and who had died (N=139,191). Included patients had received fee-for-service Medicare. The study investigators analyzed use of the BPCS in relation to the time of a patient’s death, with early BPCS use defined as occurring more than 30 days before a patient’s death.


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Overall, 5.2% of patients had made use of BPCS at any point, with 84.3% of encounters occurring in hospital settings. BPCS utilization in 2001 occurred at a rate of 0.4%. In 2015, this rate had risen to 13.3%. BPCS claims for nurse practitioners rose substantially throughout the study period.

In 2001, the median usage of BPCS occurred 6 days before death, and in 2015, the median usage had shifted to 12 days before death. Early BPCS use occurred in a low proportion of patients throughout the study period. However, the 2001 rate of early BPCS use was 0.2%, compared with 4.3% in 2015.

For patients who had survived more than 30 days post-diagnosis (n=120,741), early BPCS was associated with improved EOL care. Early BPCS use was also linked to lower average Medicare costs in the final 30 days of patients’ lives (P <.001).

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According to the researchers, further research should assess barriers to utilization of BPCS, and prospective research should be conducted on BPCS in patients with hematologic malignancies.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original abstract for a full list of disclosures.

Reference

Rao VB, Belanger E, Egan PC, LeBlanc TW, Olszewski AJ. Billed palliative care services and end-of-life care in patients with hematologic malignancies. Oral presentation at: 61st ASH Annual Meeting & Exposition; December 7-10, 2019; Orlando, FL. Abstract 384.