Factors Associated with Health Care Utilization at the End of Life for Patients with Acute Myeloid Leukemia

被引:11
作者
Vaughn, Dagny M. [1 ]
Johnson, P. Connor [1 ,2 ]
Jagielo, Annemarie D. [1 ]
Topping, Carlisle E. W. [1 ]
Reynolds, Matthew J. [1 ]
Kavanaugh, Alison R. [1 ,2 ]
Webb, Jason A. [3 ]
Fathi, Amir T. [1 ,2 ]
Hobbs, Gabriela [1 ,2 ]
Brunner, Andrew [1 ]
O'Connor, Nina [4 ]
Luger, Selina [5 ]
Bhatnagar, Bhavana [6 ]
LeBlanc, Thomas W. [7 ]
El-Jawahri, Areej [1 ,2 ]
机构
[1] Massachusetts Gen Hosp, Dept Med, Div Hematol Oncol, Boston, MA 02114 USA
[2] Harvard Med Sch, Boston, MA 02115 USA
[3] Oregon Hlth & Sci Univ, Dept Med, Div Hematol Med Oncol, Portland, OR USA
[4] Univ Penn, Sch Med, Dept Med, Philadelphia, PA USA
[5] Univ Penn, Perelman Sch Med, Dept Med, Div Hematol & Oncol, Philadelphia, PA USA
[6] West Virginia Univ, Wheeling Hosp, Inst Canc, Dept Med,Sect Hematol Oncol, Wheeling, WV USA
[7] Duke Univ, Sch Med, Dept Med, Div Hematol Malignancies & Cellular Therapy, Durham, NC USA
关键词
acute myeloid leukemia; end-of-life; health care utilization; palliative care; QUALITY-OF-LIFE; CANCER CARE; HOSPICE UTILIZATION; RACIAL-DIFFERENCES; TRAUMATIC STRESS; PALLIATIVE CARE; OLDER PATIENTS; PREDICTORS; DEPRESSION; OUTCOMES;
D O I
10.1089/jpm.2021.0249
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: Patients (>= 60 years) with acute myeloid leukemia (AML) often receive intense health care utilization at the end of life (EOL). However, factors associated with their health care use at the EOL are unknown.Methods: We conducted a secondary analysis of 168 deceased patients with AML within the United States. We assessed quality of life (QOL) (Functional-Assessment-Cancer-Therapy-Leukemia), and psychological distress (Hospital-Anxiety-and-Depression Scale [HADS]; Patient-Health-Questionnaire-9 [PHQ-9]) at diagnosis. We used multivariable logistic regression models to examine the association between patient-reported factors and the following outcomes: (1) hospitalizations in the last 7 days of life, (2) receipt of chemotherapy in the last 30 days of life, and (3) hospice utilization.Results: About 66.7% (110/165) were hospitalized in the last 7 days of life, 51.8% (71/137) received chemotherapy in the last 30 days of life, and 40.7% (70/168) utilized hospice. In multivariable models, higher education (odds ratio [OR] = 1.54, p = 0.006) and elevated baseline depression symptoms (PHQ-9: OR = 1.09, p = 0.028) were associated with higher odds of hospitalization in the last seven days of life, while higher baseline QOL (OR = 0.98, p = 0.009) was associated with lower odds of hospitalization at the EOL. Higher baseline depression symptoms were associated with receipt of chemotherapy at the EOL (HADS-Depression: OR = 1.10, p = 0.042). Higher education was associated with lower hospice utilization (OR = 0.356, p = 0.024).Conclusions: Patients with AML who are more educated, with higher baseline depression symptoms and lower QOL, were more likely to experience high health care utilization at the EOL. These populations may benefit from interventions to optimize the quality of their EOL care.
引用
收藏
页码:749 / 756
页数:8
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