Utilization of Palliative Care “Dismal” for Patients with Hematologic Malignancies

The largest-ever study of palliative care trends has shown the use of palliative care services to be “sporadic at best” for patients with hematologic malignancies. According to the review of nearly 300,000 patients, there was also significant heterogeneity in practice patterns, including National Cancer Institute (NCI)-designated practices, across all characteristics studied.

“Despite national guidelines and near universal recommendations, overall utilization of palliative care was dismal and lesser so in academic cancer programs, including NCI-designated centers,” said lead investigator Sikander Ailawadhi, MD, Oncologist, Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL, at ASH 2017. “These findings underscore the need for standardized implementation with public, healthcare provider, institutional, and political will.”

Despite the growing recognition of palliative care as an integral part of cancer treatment, data concerning practice patterns remain limited, especially for patients with hematologic malignancies. To define potential patterns in palliative care use among this patient population, Dr Ailawadhi and colleagues identified 293,518 patients in the 2016 National Cancer Database, including 147,614 with non-Hodgkin lymphoma, 59,572 with multiple myeloma, 20,634 with chronic lymphocytic leukemia (CLL), 55,827 with acute myeloid leukemia, and 9871 with Hodgkin lymphoma who were diagnosed between 2004 and 2013.

Of the 293,518 patients, only 15,325 (5.2%) received palliative care as part of their initial therapy. These services included surgery, radiation, or chemotherapy (68% of palliative care recipients); pain management (14.5%); and pain management plus surgery, radiation, or chemotherapy (5%).

The use of palliative care was significantly associated with length of survival. As the survival duration increased, a significant decrease was seen in the use of palliative care, from 7.2% in those who survived <6 months to 2.9% in patients who survived >60 months. Patients diagnosed between 2012 and 2013 who survived <6 months also had significantly higher odds of receiving palliative care than those diagnosed at the start of the study.

Although still underutilized, Dr Ailawadhi observed that patients diagnosed with multiple myeloma were most likely to receive palliative care, whereas those with CLL were least likely to receive those services. In patients who survived <6 months, increasing age, heavier symptom burden, higher literacy level, and race/ethnicity were additional factors associated with increased odds of receiving palliative care.

“In patients who survived less than 6 months, there was less use of palliative care among non-Hispanic blacks compared with non-Hispanic whites,” Dr Ailawadhi said. “Hispanics with longer than 60-month survival, however, had an increased use of palliative care services.”

Higher median income was also associated with a greater likelihood of receiving palliative care, although there was no clear trend according to survival category.

“Surprisingly, treatment at an academic research program was associated with lower likelihood of pal­liative care use compared with treatment at a nonacademic cancer program,” Dr Ailawadhi said, emphasizing the “dismal” utilization of these services.

“Despite national guidelines and near universal recommendations, there was no clear subgroup showing uniform utilization, suggesting sporadic use at best,” he concluded.

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