Vinay B Rao1, Emmanuelle Belanger2, Pamela C Egan3, Thomas W LeBlanc4, Adam J Olszewski5. 1. Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA. 2. Department of Health Services, Policy and Practice, Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA. 3. Division of Hematology/Oncology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA. 4. Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina, USA. 5. Division of Hematology/Oncology, Brown University, Providence, Rhode Island, USA.
Abstract
Background: Patients with hematologic malignancies (HM) often receive aggressive care at the end of life (EOL). Early palliative care (PC) has been shown to improve EOL care outcomes, but its benefits are less established in HM than in solid tumors. Objectives: We sought to describe the use of billed PC services among Medicare beneficiaries with HM. We hypothesized that receipt of early PC services (rendered >30 days before death) may be associated with less aggressive EOL care. Design: Retrospective cohort analysis Setting/Subjects: Using the Surveillance, Epidemiology, and End Results-Medicare registry, we studied patients with leukemia, lymphoma, myeloma, myelodysplastic syndrome, or myeloproliferative neoplasm who died between 2001 and 2015. Measurements: We described trends in the use of PC services and evaluated the association between early PC services and metrics of EOL care aggressiveness. Results: Among 139,191 decedents, the proportion receiving PC services increased from 0.4% in 2001 to 13.3% in 2015. Median time from first encounter to death was 10 days and 84.3% of encounters occurred during hospitalizations. In patients who survived >30 days from diagnosis (N = 120,741), the use of early PC services was more frequent in acute leukemia, women, and black patients, among other characteristics. Early PC services were associated with increased hospice use and decreased health care utilization at the EOL. Conclusion: Among patients with HM, there was an upward trend in PC services, and early PC services were associated with less aggressive EOL care. Our results support the need for prospective trials of early PC in HM.
Background: Patients with hematologic malignancies (HM) often receive aggressive care at the end of life (EOL). Early palliative care (PC) has been shown to improve EOL care outcomes, but its benefits are less established in HM than in solid tumors. Objectives: We sought to describe the use of billed PC services among Medicare beneficiaries with HM. We hypothesized that receipt of early PC services (rendered >30 days before death) may be associated with less aggressive EOL care. Design: Retrospective cohort analysis Setting/Subjects: Using the Surveillance, Epidemiology, and End Results-Medicare registry, we studied patients with leukemia, lymphoma, myeloma, myelodysplastic syndrome, or myeloproliferative neoplasm who died between 2001 and 2015. Measurements: We described trends in the use of PC services and evaluated the association between early PC services and metrics of EOL care aggressiveness. Results: Among 139,191 decedents, the proportion receiving PC services increased from 0.4% in 2001 to 13.3% in 2015. Median time from first encounter to death was 10 days and 84.3% of encounters occurred during hospitalizations. In patients who survived >30 days from diagnosis (N = 120,741), the use of early PC services was more frequent in acute leukemia, women, and black patients, among other characteristics. Early PC services were associated with increased hospice use and decreased health care utilization at the EOL. Conclusion: Among patients with HM, there was an upward trend in PC services, and early PC services were associated with less aggressive EOL care. Our results support the need for prospective trials of early PC in HM.
Entities:
Keywords:
Medicare; Surveillance, Epidemiology, and End Results; end-of-life care; hematologic malignancy; palliative care; population
Authors: Elizabeth J Lilley; Katherine C Lee; John W Scott; Nicole J Krumrei; Adil H Haider; Ali Salim; Rajan Gupta; Zara Cooper Journal: J Trauma Acute Care Surg Date: 2018-11 Impact factor: 3.313
Authors: Amy J Davidoff; Lisa D Gardner; Ilene H Zuckerman; Franklin Hendrick; Xuehua Ke; Martin J Edelman Journal: Med Care Date: 2014-06 Impact factor: 2.983
Authors: Daniel P Triplett; Wendi G LeBrett; Alex K Bryant; Andrew R Bruggeman; Rayna K Matsuno; Lindsay Hwang; Isabel J Boero; Eric J Roeland; Heidi N Yeung; James D Murphy Journal: J Oncol Pract Date: 2017-08-22 Impact factor: 3.840
Authors: Dorothy McCaughan; Eve Roman; Alexandra G Smith; Anne C Garry; Miriam J Johnson; Russell D Patmore; Martin R Howard; Debra A Howell Journal: BMC Palliat Care Date: 2018-02-21 Impact factor: 3.234
Authors: Emily J Labudde; Nicholas P DeGroote; Susie Smith; Jonathan Ebelhar; Kristen E Allen; Sharon M Castellino; Karen Wasilewski-Masker; Katharine E Brock Journal: Cancer Med Date: 2021-03-22 Impact factor: 4.452