Rao Vinay B, Belanger Emmanuelle, Egan Pamela C, LeBlanc Thomas W, Olszewski Adam J
Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Department of Health Services, Policy and Practice, Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA.
J Palliat Med. 2021 Jan;24(1):63-70. doi: 10.1089/jpm.2020.0006. Epub 2020 Jun 29.
Patients with hematologic malignancies (HM) often receive aggressive care at the end of life (EOL). Early palliative care (PC) has been shown to improve EOL care outcomes, but its benefits are less established in HM than in solid tumors. We sought to describe the use of billed PC services among Medicare beneficiaries with HM. We hypothesized that receipt of early PC services (rendered >30 days before death) may be associated with less aggressive EOL care. Retrospective cohort analysis Using the Surveillance, Epidemiology, and End Results-Medicare registry, we studied patients with leukemia, lymphoma, myeloma, myelodysplastic syndrome, or myeloproliferative neoplasm who died between 2001 and 2015. We described trends in the use of PC services and evaluated the association between early PC services and metrics of EOL care aggressiveness. Among 139,191 decedents, the proportion receiving PC services increased from 0.4% in 2001 to 13.3% in 2015. Median time from first encounter to death was 10 days and 84.3% of encounters occurred during hospitalizations. In patients who survived >30 days from diagnosis ( = 120,741), the use of early PC services was more frequent in acute leukemia, women, and black patients, among other characteristics. Early PC services were associated with increased hospice use and decreased health care utilization at the EOL. Among patients with HM, there was an upward trend in PC services, and early PC services were associated with less aggressive EOL care. Our results support the need for prospective trials of early PC in HM.
血液系统恶性肿瘤（HM）患者在生命末期（EOL）通常会接受积极的治疗。早期姑息治疗（PC）已被证明可改善生命末期的护理结果，但与实体瘤相比，其在HM中的益处尚不明确。我们试图描述医疗保险受益人中HM患者使用已计费PC服务的情况。我们假设接受早期PC服务（在死亡前>30天提供）可能与生命末期护理的积极性降低有关。回顾性队列分析 使用监测、流行病学和最终结果-医疗保险登记处的数据，我们研究了2001年至2015年间死亡的白血病、淋巴瘤、骨髓瘤、骨髓增生异常综合征或骨髓增殖性肿瘤患者。我们描述了PC服务使用的趋势，并评估了早期PC服务与生命末期护理积极性指标之间的关联。在139,191名死者中，接受PC服务的比例从2001年的0.4%增加到2015年的13.3%。从首次就诊到死亡的中位时间为10天，84.3%的就诊发生在住院期间。在诊断后存活>30天的患者（n = 120,7,41）中，急性白血病、女性和黑人患者等特征人群中早期PC服务的使用更为频繁。早期PC服务与临终关怀使用增加和生命末期医疗保健利用率降低相关。在HM患者中，PC服务呈上升趋势，早期PC服务与生命末期护理积极性降低相关。我们的结果支持对HM患者进行早期PC前瞻性试验的必要性。
