scholarly journals Disparities of Palliative Care Utilization in End-of-Life Hospitalized Patients with Leukemia: An Analysis of National Inpatient Sample Database

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3063-3063
Author(s):  
Tien-Chan Hsieh ◽  
Yee Hui Yeo ◽  
Guangchen Zou ◽  
Jeanine Famiglietti
Keyword(s):  
Palliative Care ◽  
African American ◽  
End Of Life ◽  
Conflicts Of Interest ◽  
Private Insurance ◽  
Hospitalized Patients ◽  
Limiting Factors ◽  
Care Utilization ◽  
National Inpatient Sample ◽  
Hospital Size

Abstract Background: Early palliative care (PC) encounter has been shown to improve the quality of end-of-life (EOL) care. There is a significant increased in the PC utility of leukemia patients in the past decade. We aim to investigate the use of PC service in hospitalized patients with leukemia and other malignancies at the end of their life. Methods: This is a retrospective study of National Inpatient Sample (NIS) with data year 2016-2018. The cohort of interest was adult patients (age at least 18) who had been hospitalized for at least three days and passed away. International Classification of Diseases, 10th Revision was used to identify patients with leukemia (myeloid, lymphoid and other types), other malignancies, comorbidities, PC encounters, and procedures. Primary outcome was PC encounter. PC-associated factors were analyzed with multivariate logistic regression. Statistical analysis was performed with SAS and R. Results: Among 404,011 hospitalized patients who passed away, a total of 254,431 patients stayed in the hospital for at least three days. There were 5,819 (lymphoid: 2,177; myeloid: 2,848; other: 794) and 56,270 patients had leukemia and other malignancies, respectively. 51.4% leukemia, 57.4% other malignancies and 46.2% non-cancer patients had PC encounter. The PC use significantly increased in all subgroups from 2016 to 2018 (p < 0.0001). The PC utility of leukemia patients improved from 47.4% in 2016 to 55.4% in 2018. Compared to patients with other malignancies, leukemia patients had higher portion of mechanical ventilation use and cardiopulmonary resuscitation (CPR) prior to their death (31.6% vs 40.0%, p < 0.005). The PC utility was significantly higher in other malignancies group (adjusted odds ratio [aOR]: 1.37, p < 0.0001) and lower in non-cancer group (aOR: 0.85, p < 0.0001). Advanced age, female, Medicaid, private insurance, self-pay, higher income, larger hospital size, urban hospital, Midwest and West Region year of 2017 and 2018 were also associated with increased PC utility and African American, Hispanic, Asian or Pacific Islander, South region were associated with lower odds of receiving PC (Figure 1). Among leukemia patients, myeloid leukemia group had higher odds of PC encounter than lymphoid group (aOR: 1.28, p < 0.0001). African American, Hispanic, lower income, and smaller hospital were associated with significantly lower PC consult in leukemia patients. Conclusion: There was an encouraging trend of increased PC consult between 2016 to 2018. Nevertheless, the PC utility was still lower among EOL hospitalized patients with leukemia than with other malignancies. Racial, socioeconomic, and hospital resource disparities were significant limiting factors of PC accessibility. Further systemic intervention and investigation are required to improve the disparities of PC utilization in leukemia patients. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Trends, Sociodemographic and Hospital-Level Factors Associated With Palliative Care Utilization Among Multiple Myeloma Patients Using the National Inpatient Sample (2016-2018)

2021 ◽  
pp. 104990912110516
Author(s):  
Inimfon Jackson ◽  
Nsikak Jackson ◽  
Aniekeme Etuk
Keyword(s):  
Multiple Myeloma ◽  
Palliative Care ◽  
Private Insurance ◽  
Care Utilization ◽  
National Inpatient Sample ◽  
Hospital Level ◽  
Cross Sectional ◽  
Factors Associated ◽  
Patient Disposition ◽  
Prevalence Trends

Background: Several factors are reported to be associated with palliative care utilization among patients with various cancers, but literature is lacking on multiple myeloma (MM) specific factors. MM patients have a high symptom burden and early involvement of palliative could increase their quality of life. We examined factors associated with palliative care utilization among MM patients and explored prevalence trends in palliative care utilization among patients with MM. Methods: Cross-sectional analyses were conducted using the National Inpatient Sample data collected between 2016 and 2018. Descriptive analyses were used to explore prevalence trends in palliative care utilization over time. Multivariable logistic regression models were used to examine sociodemographic and hospital-level factors associated with palliative care utilization in MM patients. Results: Overall prevalence of palliative care utilization in our population was 7.7% with a trend of increasing use of palliative care from 7.3% in 2016 to 8.2% in 2018. MM patients aged 70 years and above had 1.30 times higher odds (95% CI: 1.20-1.42) of receiving palliative care relative to those younger than 70 years. Compared to non-Hispanic whites, non-Hispanic blacks (Adjusted odds ratio (AOR): 0.86; 95% CI: 0.79-0.94) were less likely to utilize palliative care. Patients on Medicaid (AOR: 1.27; 95% CI: 1.08-1.49), private insurance (AOR: 1.27; 95% CI: 1.16-1.39) and other insurance types (AOR: 2.10; 95% CI: 1.79-2.47) had significantly higher odds of receiving palliative care when compared to those on Medicare. Other factors identified were hospital region, location, patient disposition, admission type, length of stay, and number of comorbidities. Conclusion: Our findings highlight the urgent need for education of hospital physicians on the need for early palliative care involvement in the care of hospitalized MM patients. Messaging interventions such as the delivery of pop-up messages in electronic medical records to serve as reminders for physicians can be explored as a potential way to increase palliative care consultations for patients who need them.

Palliative care and end-of-life health utilization in elder patients with pancreatic cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 488-488
Author(s):  
Nizar Bhulani ◽  
Ang Gao ◽  
Arjun Gupta ◽  
Jenny Jing Li ◽  
Chad Guenther ◽  
...  
Keyword(s):  
Health Care ◽  
Pancreatic Cancer ◽  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Cancer Patients ◽  
Cost Of Care ◽  
Care Utilization

488 Background: Prospective trials have shown that palliative care is associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room and Intensive Care utilization and costs in the last 30 days of life were assessed. Statistical analyses were performed with SAS version 9.4 (SAS Institute, Inc., Cary, NC). Results: Of the 72205 patients with pancreatic cancer, 3383 (4.1%) received palliative care. The proportion of patients receiving palliative care increased from 1.8% in 2000 to 7.8% in 2009 (p for trend < 0.001). Patients with palliative care were more likely to be Asian and women. Of those who received palliative care, 73% received it in the last 30 days of life, and only 11% at least 12 weeks before death. The average number of visits to the ED in the last 30 days of life were significantly higher for patients who received palliative care (0.93±0.62) versus those who did not (0.79±0.61), p < 0.001, and had a significantly higher cost of care ($1317 vs $842, p < 0.001). Intensive care unit length of stay in the last 30 days of life did not differ between patients who did and did not receive palliative care (1.14 days vs 1.04 days, p 0.08). Intensive care unit cost of care was significantly higher for patients with palliative care compared to their counterparts ($5202.641 vs $3896.750, p < 0.001). Conclusions: Palliative care use for pancreatic cancer patients has increased between 2000 and 2009 in this study of Medicare patients. However, it was largely offered close to the end of life and was not associated with reduced health care utilization or cost. Early palliative care referral may be more beneficial.

scholarly journals Simoultaneous Home Palliative Care in Onco-Hematological Patients: An Italian Single Institution Experience

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 2-3
Author(s):  
Anna Ines Gregorini ◽  
Francesca Gaia Rossi ◽  
Sara Lodi Rizzini ◽  
Valeria Ferla ◽  
Giorgia Saporiti ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Hematological Malignancies ◽  
Conflicts Of Interest ◽  
Myeloproliferative Neoplasms ◽  
Relevant Information ◽  
Disease Course ◽  
Hematological Disease ◽  
Advanced Phase ◽  
At Home

Introduction Despite their high symptomatic burden, frequent quality of life impairment, and possible incurable evolution, patients (pts) with hematological malignancies are hardly ever referred to palliative care (PC) settings. The main reasons explaining the limited resort to PC specialists by hematologists include frequent transfusion need, common infectious complications, possible unpredictable disease course and the growing availability of new and potentially active therapeutic opportunities. Additional factors may include inadequate awareness of the PC landscape, the lack of PC specialist within the hematologic care team and their scarce attitude to address the end-of-life issues with pts and families. Lastly, an intensive psychological bond between pts and their hematologists might contribute to the patient's natural preference of the hospital also for the care of terminal disease. Nonetheless, growing reported experiences confirm an overall worse end-of-life managing outside of the PC specialized settings. Methods Starting from 01/2014, in our Institution we started a collaboration with a specialized PC team including both hospice and home settings organization for onco-hematological pts. Aiming to investigate the feasibility of the integration of simultaneous home PC with active and supportive therapies, including transfusion support, for the treatment of pts affected by advanced phase hematological malignancies, we retrospectively collected disease and clinical information from clinical charts of pts who were referred to PC. The database included most relevant information with regard to PC intervention, including evaluation of end-of-life managing. Data were analyzed by descriptive statistics. Results From 01/2014 to 02/2020, 79 pts (52% males) with an onco-hematological disease were referred to home PC. Since 14 pts (18%) required multiple phases of PC assistance during their disease history (12 pts were referred twice and 2 pts three times, respectively), a total of 95 palliative care pathways were identified. Pts characteristics at PC referral are listed in table 1. Median age at the time of referral to PC was 82 years (range 40-96). Onco-hematological disease was acute leukemia (AL) in 25%, multiple myeloma (MM) in 32%, lymphoma in 25% and myelodysplastic syndrome (MDS) or myeloproliferative neoplasms (MPN) in 19% of patients. 95% of pts were informed of their diagnosis, but only 25% of pts were fully aware of the prognosis. With 75% of pts permanently living with a relative and 4% living alone, family framework was considered fully appropriate in 47% of pts, acceptable in 42% and scarce in 11%; altogether, a professional caregiver was present in 39% of pts. At the home PC referral, only 24% of pts was self-sufficient in daily activities, even though 78% was totally conscious. Overall, 36% of the pts complained at least 3 relevant symptoms among pain, hallucination, confusion, agitation, sleep disorders, dyspnea, nausea, asthenia, anxiety and psychological distress. Median duration of the home PC was 36 days, widely ranging from 1 up to 304 days. Simultaneous PC occurred in 44 pts (56%), while 35 pts (44%) continued a primarily oral hematological therapy. 39 pts (49%) received blood components transfusions in the hospital during the home PC assistance, in accord with the PC specialist. Death eventually occurred at home in 58 patients (73%), in hospice in 8 patients (10%), and in hospital in 10 patients (13%) [Table 2]. Conclusions The population referred to our home PC organization included pts with various hematological malignancies. During home PC assistance, 56% of the pts continued to attend our onco-hematology department for monitoring visit during an ongoing oral hematological therapy (44%) and/or for blood transfusion support (49%). With the vast majority of pts eventually deceasing at home or in hospice, the integration of home PC both with active hematology treatment and transfusion support appears to be feasible, meaningfully improving end of life management of patients with advanced hematological malignancies. The experience of multiple home PC pathways during the disease course in a proportion of patients offers an interesting perspective for a possible planning of temporarily palliative support in onco-hematological pts, who sometimes could still strikingly benefit of active treatments, even in very advanced phase of their disease. Disclosures No relevant conflicts of interest to declare.

scholarly journals Trends and Outcomes of Venous Thromboembolism in Hospitalized Patients with Pancreatic Cancer: Results from National Inpatient Sample Database 1998-2016

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4953-4953
Author(s):  
Hussam Alhasson ◽  
Peng Cai ◽  
Zimu Gong ◽  
Anas Saad ◽  
Muneer Al-Husseini ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Venous Thromboembolism ◽  
Length Of Stay ◽  
Conflicts Of Interest ◽  
Hospitalized Patients ◽  
Published Data ◽  
National Inpatient Sample ◽  
Inpatient Mortality ◽  
Hospital Outcomes ◽  
Annual Prevalence

Introduction: Pancreatic cancer (PC) has a known association with venous thromboembolism (VTE), with incidence of approximately 17%. There is limited published data about trends and outcomes of PC patients with VTE. The purpose of this study was to describe the prevalence and mortality trends in PC with VTE and analyze VTE impact on hospitalized PC patients from 1998 to 2016. Methods: We analyzed data from the National Inpatient Sample (NIS) database of the Agency of Healthcare Research and Quality (AHRQ). Adults≥18 years with PC as well as presence of VTE were identified by using ICD-9 or ICD-10 codes. Cost of hospitalization was adjusted for inflation in reference to 2016. Comorbidities were classified using the Elixhauser comorbidity index. Demographic characteristics, trends and in-hospital outcomes between PC with and without VTE were compared. Multiple logistic regression was used to obtain risk-adjusted odds ratio (OR) to compare inpatient mortality, length of stay (LOS), total charges, and disability at discharge between PC patients with and without VTE. The regression model was adjusted for age, sex, primary expected payer, teaching status of the hospital, hospital location, and presence of comorbid conditions. Results: 96,777 (6.5%) of a total of 1,488,543 hospitalized PC patients had an accompanying diagnosis of VTE. Mean age of the study population was 67 years. African Americans, younger age, and metastatic disease are associated with higher VTE prevalence rate. After adjusting for potential confounders, compared with those without VTE, PC patients with VTE had significantly higher inpatient mortality (12.6% vs 9.7%; OR, 1.41 [confidence interval (CI), 1.34-1.49]; P<0.001), longer LOS (8.04 vs 7.98 days; OR, 1.27 [CI, 1.23-1.32]; P<0.001), higher average cost of hospitalization (US $71,332 vs US $57,117; OR, 1.4 [CI, 1.34-1.46]; P<0.001), and greater likelihood of moderate to severe disability (defined as any beyond routine home discharge; ranging from short-term stay to skilled nursing facility to death upon discharge) (62.2% vs 50.6%, OR, 1.71 [CI, 1.65-1.78]; P<0.001). Although the annual prevalence of VTE among PC increased from 2.1% to 8.8%, in-hospital mortality declined from 23.3% in 1998 to 12.9% in 2016 (P<0.001). Conclusion: In the NIS cohort of hospitalized patients with PC and VTE from 1998-2016, annual prevalence increased while mortality overall decreased. When compared to patients without VTE, PC patients with VTE had higher inpatient mortality, longer length of stay, higher hospital cost and higher degree of disability upon discharge. Consideration for anticoagulation and interventions to limit VTE in PC patients may improve in-hospital outcomes. Figure Disclosures No relevant conflicts of interest to declare.

Patterns of palliative care utilization and end of life care in adult patients with cancer who died as inpatients at Mayo Clinic.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. e21681-e21681
Author(s):  
Collin Thomas Zimmerman ◽  
Shivani S. Shinde ◽  
Pashtoon Murtaza Kasi ◽  
Mark Robert Litzow ◽  
Jeanne M. Huddleston
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Mayo Clinic ◽  
End Of Life Care ◽  
Adult Patients ◽  
Care Utilization ◽  
Life Care ◽  
Patients With Cancer
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