End-of-Life Care Underutilized Among Older Patients With AML

Use of end-of-life care and hospice services is suboptimal among older patients with acute myeloid leukemia (AML), according to a recent study published in the Journal of Clinical Oncology (online August 7, 2017; doi:10.1200/JCO.2017.72.7149).


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Limited research exists regarding  the use of end-of-life care among patients with AML. End-of-life care is especially relevant among older adults with AML because of their relatively poor prognosis.

In a retrospective cohort study, Rong Wang, PhD, Yale School of Public Health (New Haven, CT), and colleagues evaluated a total of 13,156 patients with AML aged 66 years or older at diagnosis. All patients enrolled in the study received an AML diagnosis between 1999 and 2011 and died before December 31, 2012. Researchers assessed Medicare claims data for patterns of hospice care and use of aggressive treatment. Multivariable logistic regression analysis was used to evaluate predictors of these end points.

Results indicated that hospice care after an AML diagnosis increased from 31.3% in 1999 to 56.4% in 2012 among patients in the study. However, this increase was primarily due to late hospice enrollment during the last 7 days of life. Among the 5847 patients who enrolled in hospice, 47.4% began hospice enrollment within the last 7 days of life, and 28.8% began enrollment within the last 3 days of life. Among patients who transferred in and out of hospice care, 62% received transfusions outside of hospice. The use of chemotherapy within the last 14 days of life increased from 7.7% in 1999 to 18.8% in 2012.

Ultimately, the researchers found that older patients were less likely to receive chemotherapy or be admitted to intensive care units at the end of life, and were more likely to enroll in hospice. However, they also found that male and non-white patients were less likely to enroll in hospice and more likely to receive chemotherapy or be admitted to intensive care units at the end of life.

“End-of-life care for older patients with AML is suboptimal,” the researchers concluded. “Additional research is warranted to identify reasons for their low use of hospice services and strategies to enhance end-of-life care for these patients.” —Christina Vogt