Hospice Use Among Multiple Myeloma Patients Increases Over Time

12/07/17

Hospice use among multiple myeloma patients at the end of life has steadily increased over time, according to research presented at the 59th American Society of Hematology Annual Meeting & Exposition (December 9-12, 2017; Atlanta, GA).

Unlike other hematologic disease states, the increase in hospice use has not been accompanied by increases in late-term enrollment, according to researchers.

Late hospice enrollmentscategorized as an enrollment occurring 3 or fewer days before deathhas been common among patients with blood cancers at the end of life (EOL). Prior research has connected timely hospice enrollment with improved EOL care.

Oreofe O Odejide, MD, MPH, hematologist at Dana-Farber Cancer Institute (Boston, MA), and colleagues retrospectively reviewed the SEER-Medicare database to identify deceased patients with multiple myeloma who enrolled in hospice prior to death. Their study focused on identifying the prevalence of, and predictors for, late enrollment.

The study included data from 12,803 patients diagnosed with multiple myeloma between 2000 and 2013, who lived for at least 30 days following diagnosis. Researchers observed that 47.9% of patients enrolled in hospice care; 80.5% received hospice services in outpatient or home settings.

Patients enrolling in hospice had a median stay of 12 days, with 17.8% staying 3 days or fewer. Hospice use increased significantly over the study period, from 28.6% in 2000 to 56.4% in 2013 (P < .001). However, late enrollments did not significantly increase (2000 vs 2013, 12% vs 16.7%).

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Late enrollment was significantly associated with transfusion-dependent disease (37.9% vs 16.6%; P < .001) and receipt of dialysis (32.9% vs 16.6%; P < .001). Age, marital status, or median household income were not significantly predictive of late enrollment.

“The distinct features of myeloma as compared to other blood cancers, such as incurability and the high prevalence of pain at the EOL, may make the need for hospice services at the EOL more clear and encourage more timely enrollment,” researchers concluded.Cameron Kelsall