Early Palliative Care Services and End-of-Life Care in Medicare Beneficiaries with Hematologic Malignancies: A Population-Based Retrospective Cohort Study

Rao, Vinay; Bélanger, Emmanuelle; Egan, Pamela; LeBlanc, Thomas W.; Olszewski, Adam J.

doi:10.1089/jpm.2020.0006

Cited by 17 publications

(22 citation statements)

References 30 publications

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“…While this percentage is higher than in other pediatric studies involving deceased cohorts, 9,28,40–42 missed opportunities and late consultation remained common, with 70.3% of palliative opportunities occurring prior to or without PC involvement. Among older adults with hematologic cancer, early PC was associated with increased hospice utilization and decreased health care use at EOL 43 . In our pediatric cohort, PC consultation occurred a median of 1.8 months before death.…”

Section: Discussionmentioning

confidence: 86%

Evaluating palliative opportunities in pediatric patients with leukemia and lymphoma

et al. 2021

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Background Despite favorable prognoses, pediatric patients with hematologic malignancies experience significant challenges that may lead to diminished quality of life or family stress. They are less likely to receive subspecialty palliative care (PC) consultation and often undergo intensive end‐of‐life (EOL) care. We examined “palliative opportunities,” or events when the integration of PC would have the greatest impact, present during a patient's hematologic malignancy course and relevant associations. Methods A single‐center retrospective review was conducted on patients aged 0–18 years with a hematologic malignancy who died between 1/1/12 and 11/30/17. Demographic, disease, and treatment data were collected. A priori, nine palliative opportunity categories were defined. Descriptive statistics were performed. Palliative opportunities were evaluated over temporal quartiles from diagnosis to death. Timing and rationale of pediatric PC consultation were evaluated. Results Patients (n = 92) had a median of 5.0 (interquartile range [IQR] 6.0) palliative opportunities, incurring 522 total opportunities, increasing toward the EOL. Number and type of opportunities did not differ by demographics. PC consultation was most common in patients with lymphoid leukemia (50.9%, 28/55) and myeloid leukemia (48.5%, 16/33) versus lymphoma (0%, 0/4, p = 0.14). Forty‐four of ninety‐two patients (47.8%) received PC consultation a median of 1.8 months (IQR 4.1) prior to death. Receipt of PC was associated with transplant status (p = 0.0018) and a higher number of prior palliative opportunities (p = 0.0005); 70.3% (367/522) of palliative opportunities occurred without PC. Conclusion Patients with hematologic malignancies experience many opportunities warranting PC support. Identifying opportunities for ideal timing of PC involvement may benefit patients with hematologic cancers and their caregivers.

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Section: Discussionmentioning

confidence: 86%

Evaluating palliative opportunities in pediatric patients with leukemia and lymphoma

et al. 2021

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“…The current concept prefers early referral of palliative care because of vast bene t 33 , but the widely varied de nitions of early referral, as well as various de nitions of QOC indices and medical expenses, prohibit the generation of a solid consensus 21,28,30,38,39 . Among the previous studies evaluating the QOC and timing of palliative care consultation de ned by the survival period from consultation to death, the referral before the last 90 days 28,40 or 30 days 22,30 of patients' lives were considered "early palliative care consultation" and were associated with lower probabilities of receiving aggressive care in terminal cancer patients. In the current study, the better QOC in the HSC group started to occurred when they received HSC earlier than the eight days before their deaths.…”

Section: Discussionmentioning

confidence: 99%

“…Since palliative and hospice therapy is alternative management that replaces curative therapy for patients with cancers, these managements' initiation timing is crucial. Currently, the existing knowledge supports the concept that earlier palliative and hospice therapy or consultation is associated with better QOC and fewer medical expenses [20][21][22] . However, the cut-off time points of "early" initiation were de ned by pre-set study protocol instead of the real-world data and were widely varied from 2 weeks to 32 weeks before death in previous investigations [20][21][22] .…”

Section: Introductionmentioning

confidence: 92%

“…Currently, the existing knowledge supports the concept that earlier palliative and hospice therapy or consultation is associated with better QOC and fewer medical expenses [20][21][22] . However, the cut-off time points of "early" initiation were de ned by pre-set study protocol instead of the real-world data and were widely varied from 2 weeks to 32 weeks before death in previous investigations [20][21][22] . These shortcomings prohibited the demonstration of the whole picture regarding the association between clinical bene ts and the initiation timing of palliative and hospice care.…”

Section: Introductionmentioning

confidence: 92%

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Optimal Timing for Hospice-shared Care in Terminal Cancer Patients

Dai

Huang

Lai

et al. 2020

Preprint

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The optimal timing for initiating palliative care in cancer patients varied widely. This retrospective population-based study aimed to determine the optimal initiation timing of hospice-shared care (HSC), which maximizes the beneficial effects of quality of care (QOC) and medical expenses among terminal cancer patients. We extracted cancer patients who were in their last year of lives during 1 January 2010 to 31 December 2013 from a nationwide database. After the selection and matching process, 1,714 patients (67.7±13.2 years, 62.7% male) were enrolled and categorized into the HSC group and usual care (UC) group (n=857 in each group). By suing the generalized linear mixed-effects model for comparisons between groups, we found that the HSC groups showed generally better QOC in the four indices (with emergency room visit, hospitalization, intensive care unit admission, and receiving chemotherapy) than the UC group in those who initiated HSC 8-60 days before death. The HSC group also had significantly lower medical expenses than the UC group in those who initiated HSC 15-90 days before death. In conclusion, HSC initiation before the last eight days and 15 days of lives were found to effectively improve QOC and save medical expenses, respectively, among patients with terminal cancer.

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“…[133] However, in recent years early palliative care and attention to the quality of end-of-life care in hematologic malignancies have been more emphasized and subject to rigorous research. [134][135][136][137]…”

Section: Emerging Approaches To First-line Therapy and Palliative Carementioning

confidence: 99%

Challenges and Opportunities in the Management of Diffuse Large B-Cell Lymphoma in Older Patients

Huntington

Olszewski

2020

The Oncologist

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Most patients with diffuse large B-cell lymphoma (DLBCL) are diagnosed at age 60 or over. Challenges to effective therapy among older individuals include unfavorable biologic features of DLBCL, geriatric vulnerabilities, suboptimal treatment selection, and toxicities of cytotoxic chemotherapy. Wider application of geriatric assessments may help identify fit older patients who benefit from standard immunochemotherapy without unnecessary dose reductions. Conversely, attenuated regimens may provide a better balance of risk and benefit for selected unfit or frail patients. Supportive care with the use of corticosteroidbased prephase, prophylactic growth factors, and early institution of supportive/palliative care can help maximize treatment tolerance. Several novel or emerging therapies have demonstrated favorable toxicity profiles, thus facilitating effective treatment for elderly patients. In the relapsed or refractory setting, patients who are not candidates for stem cell transplantation can benefit from newly approved options including polatuzumab vedotin-based combinations or tafasitamab plus lenalidomide, which may have higher efficacy and/or lower toxicity than historical chemotherapy regimens. Chimeric antigen receptor T-cell therapy has been successfully applied to older patients outside of clinical trials. In the first-line setting, emerging immunotherapy options (bispecific antibodies) and targeted therapies (anti-CD20 antibodies combined with lenalidomide and/or B-cell receptor inhibitors) may provide chemotherapy-free approaches for DLBCL. Enrolling older patients in clinical trials will be paramount to fully examine potential efficacy and toxicity of these strategies. In this review, we discuss recent advances in fitness stratification and therapy that have expanded curative options for older patients, as well as future opportunities to improve outcomes in this population. The Oncologist 2020;9999:• • Implications for Practice: Management of diffuse large B-cell lymphoma in older patients poses challenges due to aggressive disease biology and geriatric vulnerability. While RCHOP remains standard first-line treatment, geriatric assessment may help evaluate patient's fitness for immunochemotherapy. Corticosteroid prephase, prophylactic growth factors, and early palliative care can improve tolerance of treatment. Novel salvage options (polatuzumab vedotin-based combinations, tafasitamab plus lenalidomide) or CAR T-cell therapy should be considered in the relapsed/refractory setting for patients ineligible for stem cell transplantation. Emerging immunotherapies (bispecific antibodies) and targeted therapies provide potential first-line chemotherapy-free approaches which need to be rigorously assessed in clinical trials that involve geriatric patients.

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Early Palliative Care Services and End-of-Life Care in Medicare Beneficiaries with Hematologic Malignancies: A Population-Based Retrospective Cohort Study

Cited by 17 publications

References 30 publications

Evaluating palliative opportunities in pediatric patients with leukemia and lymphoma

Evaluating palliative opportunities in pediatric patients with leukemia and lymphoma

Optimal Timing for Hospice-shared Care in Terminal Cancer Patients

Challenges and Opportunities in the Management of Diffuse Large B-Cell Lymphoma in Older Patients

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