Trends, Sociodemographic and Hospital-Level Factors Associated With Palliative Care Utilization Among Multiple Myeloma Patients Using the National Inpatient Sample (2016-2018)

Abstract

Background: Several factors are reported to be associated with palliative care utilization among patients with various cancers, but literature is lacking on multiple myeloma (MM) specific factors. MM patients have a high symptom burden and early involvement of palliative could increase their quality of life. We examined factors associated with palliative care utilization among MM patients and explored prevalence trends in palliative care utilization among patients with MM. Methods: Cross-sectional analyses were conducted using the National Inpatient Sample data collected between 2016 and 2018. Descriptive analyses were used to explore prevalence trends in palliative care utilization over time. Multivariable logistic regression models were used to examine sociodemographic and hospital-level factors associated with palliative care utilization in MM patients. Results: Overall prevalence of palliative care utilization in our population was 7.7% with a trend of increasing use of palliative care from 7.3% in 2016 to 8.2% in 2018. MM patients aged 70 years and above had 1.30 times higher odds (95% CI: 1.20-1.42) of receiving palliative care relative to those younger than 70 years. Compared to non-Hispanic whites, non-Hispanic blacks (Adjusted odds ratio (AOR): 0.86; 95% CI: 0.79-0.94) were less likely to utilize palliative care. Patients on Medicaid (AOR: 1.27; 95% CI: 1.08-1.49), private insurance (AOR: 1.27; 95% CI: 1.16-1.39) and other insurance types (AOR: 2.10; 95% CI: 1.79-2.47) had significantly higher odds of receiving palliative care when compared to those on Medicare. Other factors identified were hospital region, location, patient disposition, admission type, length of stay, and number of comorbidities. Conclusion: Our findings highlight the urgent need for education of hospital physicians on the need for early palliative care involvement in the care of hospitalized MM patients. Messaging interventions such as the delivery of pop-up messages in electronic medical records to serve as reminders for physicians can be explored as a potential way to increase palliative care consultations for patients who need them.

Impact of academic medical center access on outcomes in multiple myeloma

“…While NCI‐CCCs provide a significant benefit in research and funding, all ACs are characterized by their access to research and specialized providers. All categories of ACs also share high patient volumes, improved supportive care, and access to specialized treatments over other facility types 8,11 . Access to autologous stem cell transplant, which is the standard of care in eligible MM patients, is also generally only available at ACs, and many of our patients may either be selected for ACs treatment due to transplant eligibility, or benefiting from early access to transplant 9 …”

“…All categories of ACs also share high patient volumes, improved supportive care, and access to specialized treatments over other facility types. 8,11 Access to autologous stem cell transplant, which is the standard of care in eligible MM patients, is also generally only available at ACs, and many of our patients may either be selected for ACs treatment due to transplant eligibility, or benefiting from early access to transplant. 9 It is important to emphasize that demographics and socioeconomic factors associated with facility selection may also play a significant role in this survival gap.…”

“…Patients have greater access to such measures at the Commission on Cancer (CoC) accredited academic cancer centers (ACs), which are defined by the availability of MM specialists, access to comprehensive cancer treatment, and high patient volume, which has previously been shown to be independently associated with improved survival in MM 5–7 . In addition to high volume subspecialist oncologists, ACs also offer increased access to clinical trials, stem cell transplant, and large and integrated supportive care structures not available at many other facilities 8–12 …”

“…[5][6][7] In addition to high volume subspecialist oncologists, ACs also offer increased access to clinical trials, stem cell transplant, and large and integrated supportive care structures not available at many other facilities. [8][9][10][11][12] Prior studies in hematologic malignancies have examined the survival differences between facility types, where treatment at ACs is…”

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

“…3,4 Unfortunately, despite the high symptom burden, prior research has shown that palliative care remains underutilized in patients with MM and that rates of hospitalization and aggressive treatment at EOL are high. [5][6][7] Previous work on EOL in myeloma has been limited by either focusing primarily on inpatient hospitalizations, 7,8…”