Areej El-Jawahri, MD of the Massachusetts General Hospital lead a team looking at healthcare utilization during end of life care in elderly patients with acute myeloid leukemia (AML).
Since many older adults with AML have a poor prognosis, regardless of the treatment used, the authors of this study wanted to examine how healthcare was utilized for elderly AML patients and what type of end-of-life care was used.
To determine this, they performed a retrospective analysis of 98 consecutive older patients diagnosed with AML between September 1993 through to December 2011who were treated with supportive care alone at 2 tertiary care hospitals. The authors examined health care utilization including frequency of hospitalizations, clinic visits, and intensive care unit admissions and their place of death. The study also looked at health care utilization during the last 30 days of life including palliative care consultations, hospice referrals, hospitalizations, and blood transfusions.
The median age of the patients (n=98) was 77 years of age. Most were Caucasian (n=93) and slightly more than half were male (n=52).
The type of supportive care utilized included
Transfusions (n=59; 60%)
Hydroxurea and transfusions (n=23; 24%)
Hydroxyurea without transfusion support (n=9; 9%)
Transfusions and growth factor support (n=7; 7%)
Growth factor support alone (n=1; 1%)
All patients died in the study with the median time from diagnosis to death of 36.0 days (range 1-389).
During the time from diagnosis to death, patients spent an average of 36% of their time in the hospital and 8% of their life attending outpatient clinic appointments. Only 18% (n=18) and 30% (n=29) of patients utilized palliative care or hospice services, respectively.
Thirteen patients (13%) were admitted to the intensive care unit.
End of Life Care
Within 30 days of death, 88% (n=87) of patients were hospitalized.
Most patients received a blood transfusion in the last month of life (n=89; 92%) and many received a blood transfusion in the last week of life (n=58; 64%).
A large proportion of patients died in the hospital (n=45; 46%) while only 23.5% (n=23) of patients used a hospice at home or hospice facility. Approximately 21% (n=21) of patients died at home without any specific hospice care.
The authors concluded that even when no chemotherapy is used in the older patients with AML, the supportive care utilized is quite expensive. Despite this populations' poor prognosis, palliative care and hospice services are rarely utilized.
The authors suggest that better health-care delivery models be examined that better meet the needs of this population.
El-Jawahri A, Heavey SF, LeBlanc TW 2126 Health Care Utilization and End of Life Care for Older Patients with Acute Myeloid Leukemia Receiving Supportive Care Alone. Poster presented at 57th
ASH Annual Meeting; Orlando, Florida; December 4-8, 2015. Abstract 2126.