Mayo Clinic Alix School of Medicine, Mayo Clinic College of Science and Medicine, Scottsdale, Arizona, USA.
Division of Hematology and Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA.
J Palliat Med. 2022 Jan;25(1):97-105. doi: 10.1089/jpm.2021.0093. Epub 2021 Oct 27.
Patients receiving allogeneic hematopoietic cell transplantation (HCT) have high morbidity and mortality risk, but literature is limited on factors associated with end-of-life (EOL) care intensity. Describe EOL care in patients after allogeneic HCT and examine association of patient and clinical characteristics with intense EOL care. Retrospective chart review. A total of 113 patients who received allogeneic HCT at Mayo Clinic Arizona between 2013 and 2017 and died before November 2019. A composite EOL care intensity measure included five markers: (1) no hospice enrollment, (2) intensive care unit (ICU) stay in the last month, (3) hospitalization >14 days in last month, (4) chemotherapy use in the last two weeks, and (5) cardiopulmonary resuscitation, hemodialysis, or mechanical ventilation in the last week of life. Multivariable logistic regression modeling assessed associations of having ≥1 intensity marker with sociodemographic and disease characteristics, palliative care consultation, and advance directive documentation. Seventy-six percent of patients in our cohort had ≥1 intensity marker, with 43% receiving ICU care in the last month of life. Median hospital stay in the last month of life was 15 days. Sixty-five percent of patients died in hospice; median enrollment was 4 days. Patients with higher education were less likely to have ≥1 intensity marker (odds ratio 0.28, = 0.02). Patients who died >100 days after HCT were less likely to have ≥1 intensity marker than patients who died ≤100 days of HCT ( = 0.04). Death within 100 days of HCT and lower educational attainment were associated with higher likelihood of intense EOL care.
接受异基因造血细胞移植 (HCT) 的患者具有较高的发病率和死亡率，但有关生命终末期 (EOL) 护理强度相关因素的文献有限。描述异基因 HCT 后患者的 EOL 护理情况，并研究患者和临床特征与 EOL 护理强度的相关性。回顾性图表审查。总共纳入了 2013 年至 2017 年期间在梅奥诊所亚利桑那州院区接受异基因 HCT 且在 2019 年 11 月前死亡的 113 名患者。EOL 护理强度综合指标包括五个标志物：（1）未进行临终关怀登记，（2）在最后一个月入住重症监护病房 (ICU)，（3）在最后一个月住院超过 14 天，（4）在最后两周内使用化疗，以及（5）在生命的最后一周进行心肺复苏、血液透析或机械通气。多变量逻辑回归模型评估了具有 ≥1 个强度标志物与社会人口统计学和疾病特征、姑息治疗咨询和预立医疗指示文件之间的相关性。我们队列中有 76%的患者有≥1 个强度标志物，其中 43%的患者在生命的最后一个月接受 ICU 治疗。生命的最后一个月的中位住院时间为 15 天。65%的患者在临终关怀中死亡；中位登记时间为 4 天。受教育程度较高的患者不太可能具有≥1 个强度标志物（比值比 0.28， = 0.02）。与接受 HCT 后 100 天内死亡的患者相比，接受 HCT 后 100 天以上死亡的患者不太可能具有≥1 个强度标志物（ = 0.04）。HCT 后 100 天内死亡和较低的受教育程度与 EOL 护理强度增加相关。
