Quality of end‐of‐life care in patients with hematologic malignancies: A retrospective cohort study

TLDR

Limited data exist on the quality of end‑of‑life care for patients with hematologic malignancies. In a retrospective cohort of 816 decedents (113 with hematologic malignancies) who died between September 2009 and February 2010, the authors compared end‑of‑life care indicators—including ER visits, hospitalizations, ICU admissions, and systemic therapy use—in the last 30 days of life. Patients with hematologic malignancies received markedly more aggressive care, with higher rates of ER visits, hospital and ICU admissions, chemotherapy, and a higher composite aggressiveness score, and were less likely to be admitted to palliative care units (OR 6.6 for aggressive care).

Abstract

To the authors' knowledge, only limited data are available regarding the quality of end-of-life care for patients with hematologic malignancies. In this retrospective cohort study, the quality of end-of-life care was compared between patients with hematologic malignancies and those with solid tumors.All adult patients who died of advanced cancer between September 1, 2009 and February 28, 2010 while under the care of the study institution were included. The authors collected baseline demographics and end-of-life care indicators, including emergency room visits, hospitalization, intensive care unit admissions, and systemic cancer therapy use within the last 30 days of life.Of a total of 816 decedents, 113 (14%) had hematologic malignancies. In the last 30 days of life, patients with hematologic malignancies were more likely to have emergency room visits (54% vs 43%; P = .03), hospital admissions (81% vs 47%; P < .001), ≥ 2 hospital admissions (23% vs 10%; P < .001), > 14 days of hospitalization (38% vs 8%; P < .001), intensive care unit admissions (39% vs 8%; P < .001) and death (33% vs 4%; P < .001), chemotherapy use (43% vs 14%; P < .001), and targeted therapy use (34% vs 11%; P < .001) compared with patients with solid tumors. Patients with hematologic malignancies were also less likely to have palliative care unit admissions (8% vs 17%; P = .02). The composite score for aggressiveness of care (with 0 indicating the best and 6 indicating the worst) was significantly higher among patients with hematologic malignancies compared with those with solid tumors (median, 2 vs 0; P < .001). On multivariate analysis, hematologic malignancy was found to be a significant factor associated with aggressive end-of-life care (odds ratio, 6.6; 95% confidence interval, 4.1-10.7 [P < .001]).The results of the current study indicate that patients with hematologic malignancies received more aggressive care at the end of life.