Abstract

Background

Published literature provides an incomplete description of the palliative care needs of the hematologic malignancies (HM) population. We sought to compare characteristics of hospice patients with HM vs. those with solid tumors.

Methods

Patient data (2008-2012) were extracted from the electronic records of 10 hospices in the CHOICE network (Coalition of Hospices Organized to Investigate Comparative Effectiveness). We identified the subset with HM using ICD-9 codes, comparing them to the subset with all other neoplasias using bivariate analyses.

Results

Of the 48,147 cancer patients, 3,518 (7.3%) had a hematologic malignancy, with rates not changing substantially over the 5-year study period (Table 1). HM patients were somewhat older and more often male, with a slight, but significant tendency to be more often Caucasian (see Table 1). At time of admission, HM patients had worse physical functioning by Palliative Performance Scale (PPS) scores (32% vs. 24% were below 40; p<0.001) and were more likely to be admitted to an inpatient hospice or nursing home setting vs. home (OR 1.34, CI 1.16-1.56, and OR 1.54, CI 1.39-1.72; p<0.001). HM patients were more likely to have a hospice length of stay (LOS) of 1 day (OR 1.66, CI 1.49-1.86; p<0.001), or of less than 7 days (OR 1.68, CI 1.56-1.81; p<0.001). Patients with leukemia were more likely to have a LOS of 1 day compared to those with lymphoma (OR 1.31, CI 1.1-1.56; p=0.002), and were more likely to die during the study period (HR 1.23, CI 1.13-1.34; p<0.001). Patients with multiple myeloma or myelodysplastic syndrome were more likely than other HM patients to be taking an opioid at admission (OR 1.37, CI 1.12-1.67; p=0.002, and OR 1.29, CI 1.01-1.64; p =0.042). Patients with myelodysplasia were also more likely to have an advance directive or durable power of attorney in place at admission compared to other HM patients (OR 1.36, CI 1.07-1.72; p=0.012).

Table 1

Demographic and Baseline Characteristics*

DescriptorHeme (N=3,518)Solid Tumor (N=44,629)OR; 95% CIp-value
Year Admitted     
2008 752 (7.8%) 8,863   
2009 679 (7%) 8,997   
2010 702 (7.1%) 9,256   
2011 639 (7.5%) 7,863   
2012 746 (7.2%) 9,650   
     
Demographics     
Age 75.1 [13.8] 70.6 [14.2] 1.03; 1.02-1.03 < 0.001 
Gender 1,636 (46.5%) Female 22,407 (50.2%) Female 1.09; 0.99-1.19 0.06 
White 3,080 (87.6%) 37,952 (85%) 1.53; 1.26-1.86 < 0.001 
Non-white 213 (6.1%) 3,663 (8.2%)   
Missing 225 (6.4%) 3,014 (6.75%)   
     
Performance Status (PPS)     
<40 1,122 (31.9%) 10,713 (24%)  < 0.001 
40-60 1,734 (49.3%) 25,464 (57%) 0.63; 0.57-0.70 < 0.001 
70-100 62 (1.8%) 1,224 (2.74%) 0.43; 0.29-0.66 < 0.001 
     
Length of Stay 45.2 50.1  < 0.001 
1 day 382 (10.9%) 3,047 (6.8%) 1.66;1.49-1.86 < 0.001 
1 week 1,267 (36%) 11,192 (25.1%) 1.68;1.56-1.81 < 0.001 
     
DescriptorHeme (N=3,518)Solid Tumor (N=44,629)OR; 95% CIp-value
Year Admitted     
2008 752 (7.8%) 8,863   
2009 679 (7%) 8,997   
2010 702 (7.1%) 9,256   
2011 639 (7.5%) 7,863   
2012 746 (7.2%) 9,650   
     
Demographics     
Age 75.1 [13.8] 70.6 [14.2] 1.03; 1.02-1.03 < 0.001 
Gender 1,636 (46.5%) Female 22,407 (50.2%) Female 1.09; 0.99-1.19 0.06 
White 3,080 (87.6%) 37,952 (85%) 1.53; 1.26-1.86 < 0.001 
Non-white 213 (6.1%) 3,663 (8.2%)   
Missing 225 (6.4%) 3,014 (6.75%)   
     
Performance Status (PPS)     
<40 1,122 (31.9%) 10,713 (24%)  < 0.001 
40-60 1,734 (49.3%) 25,464 (57%) 0.63; 0.57-0.70 < 0.001 
70-100 62 (1.8%) 1,224 (2.74%) 0.43; 0.29-0.66 < 0.001 
     
Length of Stay 45.2 50.1  < 0.001 
1 day 382 (10.9%) 3,047 (6.8%) 1.66;1.49-1.86 < 0.001 
1 week 1,267 (36%) 11,192 (25.1%) 1.68;1.56-1.81 < 0.001 
     
*

Results presented as mean [standard deviation] for continuous variables, or count (%) for frequency variables

Conclusions

Patients with hematologic malignancies who are referred to hospice appear to be more seriously ill at time of admission, with worse physical functioning scores by PPS and shorter length of stay compared to other cancer patients. Targeted efforts to better understand the palliative care needs of the hematologic malignancies population are warranted.

Disclosures:

Abernethy:American Academy of Hospice and Palliative Medicine: Membership on an entity’s Board of Directors or advisory committees; Biovex: Research Funding; DARA: Research Funding; Helsinn: Consultancy, Research Funding; MiCo: Research Funding; Dendreon: Research Funding; Pfizer: Consultancy, Research Funding; Alexion: Research Funding; Amgen: Research Funding; Genentech: Research Funding; Bristol Myers Squibb: Consultancy, Membership on an entity’s Board of Directors or advisory committees, Research Funding; Novartis: Consultancy; Advoset: Membership on an entity’s Board of Directors or advisory committees; Orange Leaf Associates, LLC: Membership on an entity’s Board of Directors or advisory committees.

Author notes

*

Asterisk with author names denotes non-ASH members.