|The following article features coverage from the ASH 2020 virtual meeting. Click here to read more of Oncology Nurse Advisor‘s conference coverage.
Healthcare utilization during the end of life was significantly correlated with educational attainment, psychological symptoms, and quality of life (QOL) among patients with acute myeloid leukemia (AML). These findings were presented during the American Society of Hematology (ASH) 62nd Annual Meeting and Exposition.
Data from 168 deceased patients with AML were assessed for end-of-life (EOL) care and demographics, QOL, psychological distress, and health status at diagnosis. All patients had been enrolled in 1 of 2 supportive care studies conducted between 2014 and 2019.
Patients were aged median 67.35 years (range, 20.11 to 100.31), 63.7% were men, 88.1% were White, 45.2% had a college degree, and 29.2% reported a yearly income between $50,000 and $100,000. Patients had received intensive induction therapy (72.6%), median hospitalizations were 3 (range, 0 to 12), 35.7% had been admitted to the intensive care unit, most patients died in the hospital (59.5%), and 40.7% used hospice care.
During the last 30 days of life, 51.8% received chemotherapy. Treatment with chemotherapy during the final 30 days of life was positively associated with depression symptoms at diagnosis (OR, 1.10; SE, 0.05; P =.042).
During the last 7 days of life, 66.7% were hospitalized. Hospitalization during the final 7 days of life was positively associated with higher educational attainment (odds ratio [OR], 1.54; standard error [SE], 0.24; P =.006) and symptoms of depression (OR, 1.09; SE, 0.04; P =.028) and negatively associated with higher QOL (OR, 0.98; SE, 0.01; P =.009) at time of diagnosis.
This study was limited by its small sample size which was largely homogeneous and all data were collected at academic hospitals, so may not be generalizable to other populations or care centers.
Dagny M. Vaughn, MS, coauthor of the study, concluded “we observed that patients with higher depression symptoms were more likely to experience intense healthcare utilization; which underscores the importance of screening for and addressing psychological distress among AML patients.
“We also observed that patients with better quality of life at diagnosis were at lower risk for intense healthcare utilization. Patients with lower quality of life may be at higher risk for complications, and thus have a more intense courses of treatment.
“Finally, we showed that patients with higher levels of education were at higher risk for intensive health care utilization. It’s possible that [these] patients tend to seek out information regarding experimental therapies near the end of life, however, that is purely speculative.”
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original abstract for a full list of disclosures.
Vaughn DM, Johnson PC, Jagielo AD, et al. Factors associated with high healthcare utilization at the end-of-life (EOL) for patients with acute myeloid leukemia. Presented at: American Society of Hematology (ASH) 62nd Annual Meeting and Exposition; December 5-8, 2020. Abstr 433.