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Patients with hematologic malignancies had poorer end-of-life (EOL) care compared with patients who had solid tumors. These findings were presented during the American Society of Hematology (ASH) 62nd Annual Meeting and Exposition.
This study analyzed data from the Surveillance, Epidemiology and End Results (SEER)-Medicare database, which collects information from approximately 30% of the population in the United States. End-of-life care quality of 59,352 patients with solid tumors (breast, lung, colorectal, prostate cancers) and 18,185 with hematologic malignancies (leukemia, lymphoma, myeloma, myelodysplastic syndrome, myeloproliferative neoplasms) who died between 2011 and 2015 was assessed.
Patients were aged median 76.6 (interquartile range [IQR], 71.2-83.0) and 79.5 (IQR, 73.2-85.5) years at death, 50.7% and 54.2% were men, and the median National Cancer Institute comorbidity index was 2.94 (IQR, 1.34-4.63) and 2.99 (IQR, 1.34-4.92) among patients with solid tumors and hematologic malignancies, respectively.
Patients with hematologic malignancies were less likely to enroll in hospice (58% vs 67%; adjusted risk ratio [aRR], 0.85; 95% CI, 0.84-0.86). Among those who did enroll in hospice, compared with patients with solid tumors, those with hematologic malignancies had shorter lengths of stay in hospice care (median 9 vs 14 days; aRR, 0.81; 95% CI, 0.79-0.83) and were more likely to stay for fewer than 3 days (32% vs 23%; aRR, 1.14; 95% CI, 1.24-1.35). Among patients with solid tumors, the median length of stay in hospice care increased from 10 days in 2011 to 14 in 2015 (P <.001). This trend was not observed among patients with hematologic malignancies (P =.077).
During the 30 days before death, patients with hematologic malignancies had costlier care ($17,800 vs $11,900; adjusted means ratio, 1.52; 95% CI, 1.49-1.56), spent more time in the hospital (4 vs 2 days; adjusted means ratio, 1.55; 95% CI, 1.52-1.59), and were more likely to be admitted to the intensive care unit (aRR, 1.32; 95% CI, 1.29-1.35).
During EOL care patients with hematologic malignancies were less likely to use opioids (aRR, 0.81; 95% CI, 0.79-0.84) and more likely to require a transfusion (aRR, 4.34; 95% CI, 4.11-4.58).
The study authors concluded patients with hematologic malignancies appeared to receive inferior care during the end of their life compared with patients who had solid tumors.
Pamela C. Egan, MD, coauthor of this research, stated, “I think there’s a lot of areas where we could work to improve these outcomes. One is trying to identify and meet the unique palliative needs that these patients have, for example to change the Medicare-hospice benefit so it will cover transfusions. I think that would go a long way towards addressing these disparities.”
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original abstract for a full list of disclosures.
Egan PC, Belanger E, Panagiotou OA, et al. Comparison of end-of-life care quality outcomes and indicators of palliative needs between Medicare beneficiaries with solid and hematologic malignancies. Presented at: American Society of Hematology (ASH) 62nd Annual Meeting and Exposition; December 5-8, 2020. Abstr 218.