Quality of end‐of‐life care in multiple myeloma: A 13‐year analysis of a population‐based cohort in Ontario, Canada

Abstract

Summary Optimizing end‐of‐life (EOL) care for multiple myeloma (MM) represents an unmet need. An administrative cohort in Ontario, Canada was analysed between 2006 and 2018. Aggressive care was defined as two or more emergency‐department visits in the last 30 days before death, or at least two new hospitalizations within 30 days of death, or an intensive care unit (ICU) admission within the last 30 days of life. Supportive care was defined as a physician house‐call in the last two weeks before death, or a palliative nursing or personal support visit at home in the last 30 days before death. Among 5095 patients, 23.2% of patients received chemotherapy at EOL and 55.6% of patients died as inpatient. A minority received aggressive care at EOL [28.3%: autologous stem cell transplant (ASCT), 20.4%: non‐ASCT], and a majority received supportive care at EOL (65.4%: ASCT, 61.5%: non‐ASCT). Supportive care was less likely to be received by those aged over 80 years and in lower‐income neighbourhoods. Supportive care at EOL increased from 56.0% in 2006 to 70.3% in 2018. Despite improvements, many patients with MM experience aggressive care at EOL. Even in a publicly funded health care system, disparities based on age, income and community size are present.

Treatment sequences and drug costs from diagnosis to death in multiple myeloma

“…We found that a notably higher percentage of patients received active treatment in the last 30, 14 and 7 days before death (68%, 50% and 33%, respectively) compared with previous studies (in which 23% of patients received chemotherapy during the last 14 days). 23 This is important, as monthly drug costs of this limited extension of lifespan (extension) were twice as high as the average monthly overall lifetime drug costs, with the last 3 months constituting 10% of the total lifetime drug costs.…”

“…Healthcare utilisation in MM patients during end-of-life has been studied to some extent, showing that a substantial number of patients receive chemotherapy in the last 14 days and are hospitalised in the last 30 days before dying. 23 However, data on which medications are administered and the corresponding drug costs are lacking. 10,11,23,24 In addition, while treatment patterns in daily clinical practice have been reported previously, a complete overview for all patients (i.e., follow-up until death for all patients) is absent.…”

“…23 However, data on which medications are administered and the corresponding drug costs are lacking. 10,11,23,24 In addition, while treatment patterns in daily clinical practice have been reported previously, a complete overview for all patients (i.e., follow-up until death for all patients) is absent. Finally, the definition of the end-of-life phase is not well-established and varies from the last 14 days to 12 months among studies, 10,11,23,24 providing an opportunity to explore end-of-life costs in a broader context.…”

Quality of End-of-Life Care in Gastrointestinal Cancers: A 13-Year Population-Based Retrospective Analysis in Ontario, Canada

“…Most of our population received some type of palliative care in the last year of life ( n = 65,076, 93.0%), and most received a palliative care homecare service in the last 30 days of life ( n = 45,327, 70.0%). The use of supportive care in the last 30 days of life is comparable to other specific cancers, such as 82.1% in multiple myeloma and 69.8% in gynecologic cancers; though these are historically cancers with lower rates of palliative care utilization at end of life [ 19 , 20 ].…”

Palliative care for patients with hematological malignancies—beyond specialist care

“…Encouragingly, despite previous reports of hesitancy by hemato-oncologists (6-8), there seems to be a growing understanding that early integration of PC may be beneficial for HM patients. Recent studies have shown improvements in referral to specialist PC for patients with HM across settings although many HM patients continue to experience aggressive care at the EOL (9,10). We are hopeful that as seen in other fields of medicine, we will see…”