Palliative Care Use Remains Low Among Patients With Hematologic Malignancies

11/30/17

Palliative care utilization among patients with hematologic malignancies remains extremely low, according to data presented at the 59th American Society of Hematology Annual Meeting & Exposition (December 9-12, 2017; Atlanta, GA).

Patients treated at academic medical centers, include National Cancer Institute (NCI)designated centers, showed lower utilization patterns, and researchers observed no patterns of uniform utilization in any one disease subgroup.

Despite recommendations from professional societies and advocacy groups recommending palliative care for patients with hematologic malignancies as part of initial treatment, little data have been presented regarding actual patterns of use. Sikander Ailawadhi, MD, oncologist at Mayo Clinic (Jacksonville, FL), and colleagues queried the National Cancer Database (NCDB) to determine the receipt of palliative care among deceased patients treated between 2004 and 2013.

The study included data from 293,518 patients, the majority of whom had non-Hodgkin lymphoma (n = 147,614). Other disease states included multiple myeloma (MM; n = 59,572), acute myeloid leukemia (AML; n = 55,827), chronic lymphocytic leukemia (CLL; n = 20,634), and Hodgkin disease (n = 9871).

Researchers stratified patients by survival duration (< 6 months, 6-24 months, 24-60 months, or 60+ months).

Dr Ailawadhi and colleagues observed that 5.2% of patients (n = 15,352) received palliative care as part of their initial treatment. Patients diagnosed in the later portion of the study quadrant (2012-2013) who survived fewer than 6 months showed a higher likelihood of palliative care receipt than those diagnosed between 2004 and 2005 (odd ratio [OR], 1.28; 95% CI, 1.17-1.39); no significant interactions were seen in patients with longer survival.

The most common palliative methods used (68%) were surgery, radiation, and chemotherapy. Pain management was used in 14.5% of patients, and a combination in 5%; palliative care of unknown modality was used by 12.5% of patients.

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The researchers saw a significant (P < .001) decrease in palliative care use among patients with a longer survival interval, from 7.2% in patients surviving fewer than 6 months to 2.9% in patients surviving more than 60 months.

Using AML as a reference, the highest palliative care utilization was seen among patients with MM in all survival groups (OR, 2.65-59.56); the lowest was seen among CLL patients in all groups (OR, 0.51-2.94).

Increased palliative care use was correlated with increased age in patients who survived fewer than 6 months and between 6 and 24 months (P < .001), and for patients with higher Charlson Comorbidity Index scores who survived fewer than 6 months (P < .001). Receipt was not correlated with gender.

Non-Hispanic blacks who survived fewer than 6 months had lower palliative care use than non-Hispanic whites in the same survival quadrant (OR, 0.9; 95% CI, 0.82-0.98); Hispanic patients displayed significantly better receipt of palliative care with increased survival (60+ months: OR, 1.7; 95% CI, 1.09-2.63).

Patients treated at academic or research centers, including NCI centers, showed a significantly lower utilization of palliative care than nonacademic cancer centers among patients surviving between 24 and 60 months (OR, 0.85; 95% CI, 0.76-0.94) and more than 60 months (OR, 0.74; 95% CI, 0.61-0.89).

“Despite national guidelines and near-universal recommendations, overall utilization of palliative care was dismal,” researchers wrote. “We noted significant heterogeneity in practice patterns by all characteristics studied, underscoring the need for standardized implementation with public, health care providers, institutions, and political will.”Cameron Kelsall