Disentangled: A single institutional analysis comparing differences in end-of-life patterns and resource utilization in acute leukemia and bone marrow transplant units.

Authors

null

Gene Decastro

Northwell Health, Manhasset, NY

Gene Decastro, Samuel Anandan, Adam Ginsberg, Santiago Lopez

Organizations

Northwell Health, Manhasset, NY, Northwell Health: Division of Geriatrics and Palliative Medicine, Manhasset, NY

Research Funding

Other

Background: The impact of palliative medicine in patients with hematologic malignancies is a growing area of investigation. Over the last year, the Palliative Medicine service at North Shore University Hospital (NSUH) has developed and sustained a co-management model for patients admitted to the acute leukemia (ALU) or bone marrow transplant (BMTU) units. Methods: The primary outcome measure was the time from admission to initial consult. The secondary outcome measure was length of stay in a goal concordant setting to receive end of life (EOL) care, namely our inpatient palliative care unit (PCU). Results: There were 106 new consults in twelve months (45 acute leukemia/lymphoma consults and 61 bone marrow transplant consults). The principal diagnosis seen on the ALU was acute myeloid leukemia (56%), whereas on the BMTU it was multiple myeloma (28%). The average time to consult for the ALU decreased from 18.8 days at 6 months to 8.8 days at 12 months. For the BMTU, time to consult decreased from 10.2 days at 6 months to 4.6 days at 12 months. The mortality rate of patients seen from the ALU and BMTU was 40% and 12%, respectively. Of the ALU population deaths, 83% were 65 or older, compared to 29% of the BMTU deaths. Mortality events in the ICU were greater for BMTU patients (43%) relative to ALU patients (11%). Fifty percent of the ALU inpatient expirations were able to receive EOL care in our PCU. The remaining deaths were in the ALU (39%) or ICU (11%). For BMT patients, 57% died on the BMTU, and 43% in the MICU. Despite comparable numbers of PCU transfers during the pre- and post-intervention period, our initiative increased the average LOS in the PCU from 1.1 to 5.7 days. Of the ALU patients electing DNR prior to death (83%), the average DNR-to-death days was 10.6 days, whereas BMTU patients who elected DNR prior to death (50%) had an average of 6.5 DNR-to-death days. Conclusions: This partnership allowed for recognition of differences in EOL care patterns across these populations. It has demonstrated a benefit by accelerating time to consult and enhancing transitions to goal concordant settings for patients with hematologic malignancies at the end of their lives.

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Abstract Details

Meeting

2018 Palliative and Supportive Care in Oncology Symposium

Session Type

Poster Session

Session Title

Poster Session A: Communication and Shared Decision Making; Integration and Delivery of Palliative and Supportive Care; and Psychosocial and Spiritual/Cultural Assessment and Management

Track

Integration and Delivery of Palliative and Supportive Care,Communication and Shared Decision Making,Psychosocial and Spiritual/Cultural Assessment and Management

Sub Track

Integration and Delivery of Palliative and Supportive Care

Citation

J Clin Oncol 36, 2018 (suppl 34; abstr 90)

DOI

10.1200/JCO.2018.36.34_suppl.90

Abstract #

90

Poster Bd #

C10

Abstract Disclosures

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