Background: Patients (pts) with hematologic malignancies (HMs) often receive aggressive care at the end of life (EOL), leading to lower quality of life. Early palliative care (PC) may improve EOL care, but its benefits are less established in HMs than in solid tumors. We sought to describe the use of billed PC services (BPCS) among Medicare beneficiaries with HMs and associated EOL quality measures.

Methods: Using the linked SEER-Medicare registry, we studied Medicare beneficiaries diagnosed with leukemia, lymphoma, myeloma, myelodysplastic syndrome, or myeloproliferative neoplasm who died from 2001-2015. We described trends in the use of BPCS (identified by codes in clinician encounter claims). Among pts surviving >30 days from diagnosis, we compared baseline characteristics and EOL care quality metrics for pts with and without “early BPCS” (initiated >30 days before death).

Results: The proportion of pts (N=139,191, median age 81 years) with any BPCS increased from 0.4% in 2001 to 13.3% in 2015. Median time from first BPCS encounter to death was 10 days and 84.3% occurred during hospital admissions. Use of early BPCS was rare (from 0.2% in 2001 to 4.3% in 2015, with 28% of all first BPCS occurring early) and more frequent in acute leukemia, among black pts, those with higher comorbidity indices or poor performance statuses, and those receiving chemotherapy. Receipt of early BPCS was associated with improved EOL care quality metrics (see Table).

Conclusions: Use of BPCS among Medicare beneficiaries with HMs has steeply increased in recent years, but most encounters still occur within days of death. Early BPCS are associated with better EOL care quality metrics similar to those observed in solid tumors. Our results support the need for prospective trials of early PC for pts with HMs.

EOL care quality metrics	No early BPCS	Early BPCS	P a
N	118,728	2,013
Death on hospice	47%	64%	<.001
Days on hospice, median	9	22	<.001
> 3 days on hospice	73%	84%	<.001
> 1 ED visit, last 30 days	13%	11%	<.001
> 1 hospitalization, last 30 days	14%	9%	<.001
ICU admission, last 30 days	37%	28%	<.001
Inpatient death	38%	27%	<.001
Chemotherapy use, last 14 days	7%	4%	<.001

^aMultivariable model adjusting for patient and disease characteristics