As reported in the Journal of Clinical Oncology by Wang et al, many older patients with acute myeloid leukemia (AML) do not receive hospice care at the end of life, with those who do tending to enroll in hospice within days of death.
The population-based retrospective cohort study involved analysis of the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to identify patients with AML who were aged ≥ 66 years at diagnosis, diagnosed between 1999 to 2011, and died before the end of December 2012.
Patterns of Care
Among 13,156 patients in the cohort, median survival was 2.4 months. The proportion receiving hospice care after diagnosis increased from 31.3% in 1999 to 56.4% in 2012. This increase largely reflected an increase in the proportion of patients with hospice enrollment in the last 7 days of life.
Of the entire cohort, 5,847 patients (44.4%) were enrolled in hospice; of them, 47.4% and 28.8% started first hospice enrollment in the last 7 and last 3 days of life, respectively. A total of 5,662 (43.0%) died in the hospital, and 5,322 (40.5%) died in hospice. Compared with patients dying within 30 days after diagnosis, those with longer survival were more likely to enroll in hospice (48.1% vs 30.7%, P < .01). First hospice enrollment in the last 3 days of life occurred for 51.2% of patients dying within 30 days of diagnosis and for 24.9% of those with a longer survival.
Among 89 patients who transferred in and out of hospice care, 62% received transfusions outside hospice. The use of chemotherapy within the last 14 days of life increased from 7.7% in 1999 to 18.8% in 2012. Male and nonwhite patients were less likely to enroll in hospice and more likely to receive chemotherapy and to have intensive care admission at the end of life. Older patients were less likely to receive chemotherapy and to have intensive care admission at the end of life and more likely to enroll in hospice.
The investigators concluded: “End-of-life care for older patients with AML is suboptimal. Additional research is warranted to identify reasons for their low use of hospice services and strategies to enhance end-of-life care for these patients.”
The study was funded by the National Cancer Institute.
Rong Wang, PhD, of the Yale School of Public Health, is the corresponding author of the Journal of Clinical Oncology article.
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