Comparing end‐of‐life care of hematologic malignancy versus solid tumor patients in a tertiary care center

Abstract

ObjectivesTo compare end‐of‐life (EOL) care for solid tumor and hematologic malignancy (HM) patients.MethodsWe collected data on the last 100 consecutive deceased HM and 100 consecutive deceased solid tumor patients who died prior to June 1st 2020, treated at a single center. We compared demographic parameters, cause of death as ascertained by review of medical records by two independent investigators, and EOL quality indicators including: place of death, use of chemotherapy or targeted/biologic treatment, emergency department visits as well as hospital, inpatient hospice and Intensive Care Unit admissions and the time spent as inpatient over the last 30 days of life; mechanical ventilation and use of blood products during the last 14 days of life.ResultsIn comparison with solid tumor patients, HM patients more commonly died from treatment complications (13% vs. 1%) and unrelated causes (16% vs. 2%, p < .001 for all comparisons). HM patients died more frequently than solid tumor patients in the intensive care unit (14% vs. 7%) and the emergency department (9% vs. 0%) and less frequently in hospice (9% vs. 15%, p = .005 for all comparisons). In the 2 weeks prior to death HM patients were more likely than solid tumor patients to undergo mechanical ventilation (14% vs. 4%, p = .013), receive blood (47% vs. 27%, p = .003) and platelet transfusions (32% vs. 7%, p < .001); however, no statistical difference was found in use of either of chemotherapy (18% vs. 13%, p = .28) or targeted treatment (10% vs. 5%, p = .16).ConclusionsHM patients were more likely than solid tumor patients to undergo aggressive measures at EOL. Rarity of HM deaths, frequently caused by complications of treatment and unrelated causes, may affect treatment choices at EOL.

Utilization and quality of palliative care in patients with hematological and solid cancers: a population-based study

“…Other reasons for the differences in PC rates and time frames are that most of the listed studies either included a specific patient group or specific diagnoses (Beaussant et al 2018 ; Rao et al 2020 ; Salas et al 2022 ) or had smaller sample sizes (Burstein et al 2023 ; Cheng et al 2005 ; Howell et al 2015 ; Hui et al 2014 ). Some of the data in these studies are also more than 10 years old (Cheng et al 2005 ; Howell et al 2010b ; Hui et al 2014 ).…”

“…Often treatment of various HM is associated with complications, including cytopenias, sudden bleeding, thromboembolic events, and severe anemia, as well as infections (Burstein et al 2023 ; Salas et al 2022 ). These complications often require hospitalization for monitoring and management of therapy (Egan et al 2020b ).…”

“…These complications often require hospitalization for monitoring and management of therapy (Egan et al 2020b ). In addition, many patients with HM continue their therapies until the end of life, resulting in additional side effects and requiring hospitalization for monitoring and administration of therapy (Burstein et al 2023 ; Dasch et al 2017 ; Hui et al 2014 ).…”

“…Analysis of previous studies has shown that the research landscape is fragmented. Some studies are from single medical centers (Allende-Pérez et al 2023 ; Burstein et al 2023 ; Cheng et al 2015 ; Dasch et al 2017 ; Eichenauer et al 2019 ; Hui et al 2014 ; Ishida et al 2019 ; Pasquarella et al 2022 ), which may limit the generalizability of their findings. Occasionally, investigations are limited to specific patient populations, such as hospitalized patients (Beaussant et al 2018 ; Dasch et al 2017 ; Salas et al 2022 ) or emergency department patients (Verhoef et al 2020 ), or individual disease groups such as leukemia (Cheng et al 2015 ; Salas et al 2022 ) or multiple myeloma (Odejide et al 2018 ).…”