Lack of Access to Transfusions Limits Hospice Use by Patients With Blood Cancer

Key Points

  • 68.1% of physicians surveyed strongly agreed that hospice care is “helpful” for patients with blood cancers.
  • However, 46% of the respondents replied that home hospice is “inadequate” for their patients’ needs.
  • 26.8% of the physicians agreed or strongly agreed that they would make more referrals to hospice if their patients could continue to have regular clinic visits after hospice begins.

A new survey finds that doctors would refer more patients with incurable blood cancers to hospice for end-of-life care if they could receive transfusions, which are generally not available because of hospice reimbursement policies. The findings, published by Odejide et al in Cancer, help explain why patients with leukemia, lymphoma, and other hematologic malignancies are less likely to receive hospice care at the end of life than are patients with solid tumors.

Researchers from Dana-Farber Cancer Institute found that a majority of hematologic oncologists strongly agreed that hospice care has value for patients with blood cancers; however, nearly half of the physicians in the survey felt home hospice is inadequate for their patients’ needs. Many patients with blood cancers need transfusions of red cells or platelets to control their symptoms, and most outpatient hospice settings don’t provide this service.

Oreofe Odejide, MD, MPH, first author of the study and a physician in Dana-Farber’s Center for Lymphoma as well as a member of the Division of Population Sciences at Dana-Farber, said that Medicare typically provides a fixed cost per-diem reimbursement for hospice care that would not cover the cost of blood or platelet transfusions. In addition, much hospice care occurs in the patient’s home, where transfusions are impractical, said Dr. Odejide, although transfusions can be given in an outpatient clinic.

Previous research found that patients with blood cancers have the lowest rates of hospice use of all cancer patients and, compared with patients having solid tumors, are more likely to enroll in hospice late—within 3 days of death.

Findings

Dr. Odejide and her colleagues, including senior author Gregory A. Abel, MD, MPH, of Dana-Farber, surveyed hematologic oncologists in an effort to explain the disparity in hospice use.

Of the 349 physicians who responded, 68.1% strongly agreed that hospice care is “helpful” for patients with blood cancers. Doctors whose practices included greater numbers of patients with solid tumors in addition to blood cancer patients were more likely to strongly agree on the value of hospice. However, 46% of the respondents replied that home hospice is “inadequate” for their patients’ needs. More than half of the doctors surveyed said they would be more likely to refer to hospice if red cell and/or platelet transfusions were available. Also, 26.8% of the physicians agreed or strongly agreed that they would make more referrals to hospice if their patients could continue to have regular clinic visits after hospice begins.

The takeaway finding, the authors said, is that “although hematologic oncologists value hospice, rates of referral are relatively low because the current hospice model may not meet the practical needs of blood cancer patients.” In addition, the researchers said, “the fact that pain—a major focus of hospice—is less prevalent among patients with hematologic cancers compared to solid malignancies may further foster the viewpoint that hospice services are less relevant.”

Based on their findings, the authors suggest that referrals to hospice for patients with blood cancer might increase if additional hospice services tailored to their specific needs (eg, transfusions) were available—and that would require changes in hospice reimbursement policies. Although providing transfusions would raise hospice costs, they concluded, “there would likely be concomitant cost savings through increased hospice enrollment leading to a reduction in terminal hospitalizations and/or intensive, nonefficacious treatments.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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