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Researchers from the Kansas University Medical Center observed that more than 40% of patients with multiple myeloma (MM) died during hospitalization, and many required significant interventions. These findings were presented during the American Society of Hematology (ASH) 62nd Annual Meeting and Exposition.
Data for this study came from the National Inpatient Sample (NIS) database, which includes information from all inpatients in the United States. Patients (N=233,932) who were admitted to a hospital with MM between 2002 and 2014 were assessed for transfusions, infections, and hospitalization cost. MM mortality rates were obtained through the Center for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI).
The CDC and NCI reported 10,913 MM deaths in 2002 and 12,112 in 2014. The total number of MM deaths over the study period was 144,105.
Among patients hospitalized with MM, 6.3% died during their hospital stay. Among all MM-related deaths, 48.4% occurred in the hospital, and a general trend of decreased deaths during hospitalization was observed (53.4% in 2002 vs 41.4% in 2014; P <.01). The reduction of deaths in hospital was similar to the general population in the United States.
Among patients who died during hospitalization, 35.8% required blood transfusions and 6644 infections were identified, nearly half of which (45.0%) led to death.
Over time, fewer patients who died from MM had hypertension (P <.001) or atrial fibrillation (P <.001) and more patient deaths occurred among Black patients (P =.0005) and women (P =.04).
The use of palliative or hospice care was observed to increase over time from 5.3% in 2002 to 33.57% in 2014 (P <.01). The cost of hospitalization increased from $48,709 in 2002 to $104,115 in 2014 (P <.01).
This study did not include information for patient-specific cancer characteristics or on palliative care use outside the inpatient setting.
These data indicated that although deaths due to MM during hospitalization were decreasing over time in the United States, hospital deaths still remained high.
To decrease the rate of death during hospitalization and to increase palliative or hospice care use, Ghulam Mohyuddin, MD, coauthor of this research, stated, “Given the significant requirement for transfusions in our data, it is important to note the significant barriers of getting blood transfusions for patients with hematological malignancies enrolled on hospice. Further work is needed to improve access to blood transfusions for these patients.”
Abbasi S, McClune B, Abdallah AO, Shune L, Mohyuddin GR. Hospitalization at the end of life in myeloma patients: lessons from the National Inpatient Sample. Presented at: American Society of Hematology (ASH) 62nd Annual Meeting and Exposition; December 5-8, 2020. Abstr 210.