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End-of-life care 'suboptimal' in elderly patients with acute myeloid leukemia

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August 18, 2017

End-of-life care appeared suboptimal for elderly patients with acute myeloid leukemia, with increased use of hospice care occurring mostly in the last 7 days of life, study data showed.

“The prognosis of older patients with acute myeloid leukemia is poor and has remained unchanged over the past several decades,” Rong Wang, PhD, research scientist in the department of chronic disease epidemiology at the Yale School of Public Health, and colleagues wrote. “Hence, end-of-life care is particularly relevant for this population.”

Cautious approaches to intensive treatment and adequate use of hospice care are considered measures of quality for end-of-life care.

“Although these measures are accepted by most hematologists, patients with hematologic malignancies often underuse hospice and receive more end-of-life intensive care,” Wang and colleagues wrote.

The researchers carried out a population-based retrospective cohort study of patients with AML aged 66 years or older at time of diagnosis (n = 13,156). All patients received their diagnoses between 1999 and 2011, and died before Dec. 31, 2012. Wang and colleagues reviewed Medicare claims to assess patterns of hospice care and the use of aggressive treatment. The researchers used multivariable logistic regression analysis to determine predictors of hospice care and aggressive treatment.

Hospice care rose after diagnosis rose from 31.3% in 1999 to 56.4% in 2012. Most of this increase resulted from hospice enrollment in the final week of life. Nearly half (47.4%) of 5,847 patients who enrolled in hospice did so in the final 7 days of life; 28.8% enrolled in the final 3 days of life. Among patients who transferred into and out of hospice, more than half (62%) received transfusions outside of hospice care.

The use of chemotherapy in the final two weeks of life also increased, from 7.7% in 1999 to 18.8% in 2012. Male and nonwhite patients appeared less likely to use hospice and more likely to be admitted to ICUs or undergo chemotherapy at the end of life. Older patients were more likely to enroll in hospice and less likely to receive chemotherapy.

“We found that the current end-of-life care for older patients with AML is suboptimal, as reflected by low hospice enrollment and high use of potentially aggressive treatment,” the researchers wrote. “Transfer in and out of hospice was associated with the receipt of transfusions. Changes to current hospice services, such as enabling the provision of transfusion support, and improvements in physician-patient communications, may help facilitate better end-of-life care in this patient population.” – by Andy Polhamus

Disclosures: Wang reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.

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