End-of-Life Care After Allogeneic Hematopoietic Cell Transplantation
Posted: Monday, October 15, 2018
To learn more about end-of-life care in patients with hematologic malignancies who undergo allogeneic hematopoietic cell transplantation (HCT), oncologist Emily E. Johnston, MD, of the University of Alabama at Birmingham (UAB) Institute of Cancer Outcomes and Survivorship, and colleagues undertook a population-based analysis of 2,135 patients who died within 1 year of undergoing the procedure. They sought to highlight the “concordance (or lack thereof) between the intensity of end-of-life care and the patient’s wishes.”
Allogeneic HCT may be the only curative option for patients with multiple myeloma. In this study, the vast majority of patients with malignancies had acute myeloid leukemia/myelodysplastic syndrome, acute lymphoblastic leukemia, or lymphoma.
The intensity rates for these patients, who underwent allogeneic HCT and died between 2000 and 2013 in California, were “much higher than those found in general oncology patients,” noted Dr. Johnston and her team. “The most common intensity markers were hospital death, intensive-care unit admission, and intubation. More than 80% died in the hospital, more than 40% spent the last 30 days of life in the hospital, and more than 45% were admitted to the ICU near the end of life, with 105 hospital days in their last year of life.”
The patients with higher-intensity end-of-life care included those aged 15 to 21 and 30 to 59 years, those with acute lymphoblastic leukemia versus other malignancies, and those with comorbidities at the time of transplantation.
However, these data do not show whether high-intensity treatment was what the patients, and their caregivers, would have preferred. “We need to start having end-of-life care conversations earlier with patients,” Dr. Johnston said in an interview with UAB News. “My hope is that, through continued studies, we can better give patients the opportunity to die in the location they want after receiving care that is consistent with their end-of-life goals.”