Association between palliative care and end-of-Life care for patients with hematological malignancies: A population-based study

Medicine (Baltimore). 2019 Oct;98(40):e17395. doi: 10.1097/MD.0000000000017395.

Abstract

To date, few studies have examined the end-of-life (EOL) care for patients with hematological malignancies (HMs). We evaluated the effects of palliative care on the quality of EOL care and health care costs for adult patients with HMs in the final month of life.We conducted a population-based study and analyzed data from Taiwan's Longitudinal Health Insurance Database, which contains claims information for patient medical records, health care costs, and insurance system exit dates (our proxy for death) between 2000 and 2011.A total of 724 adult patients who died of HMs were investigated. Of these patients, 43 (5.9%) had received only inpatient palliative care (i-Pal group), and 19 (2.6%) received home palliative care (h-Pal group). The mean health care costs during the final month of life were not significantly different between the non-Pal and Pal groups (p=0.315) and between the non-Pal, i-Pal, and h-Pal groups (p=0.293) either. By the multivariate regression model, the i-Pal group had lower risks of chemotherapy, ICU admission, and receipt of CPR, but higher risks of at least two hospitalizations and dying in hospital after adjustments. The h-Pal group had the similar trends as the i-Pal group but lower risk of dying in hospital after adjustments.Patients with HMs who had received palliative care could benefit from less aggressive EOL cancer care in the final month of life. However, 8.6% patients with HMs received palliative care. The related factors of more hospitalizations and dying in hospital warrant further investigation.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use
  • Comorbidity
  • Female
  • Health Expenditures / statistics & numerical data
  • Hematologic Neoplasms / drug therapy
  • Hematologic Neoplasms / economics
  • Hematologic Neoplasms / epidemiology*
  • Home Care Services / economics
  • Home Care Services / statistics & numerical data*
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data
  • Humans
  • Intensive Care Units / economics
  • Intensive Care Units / statistics & numerical data
  • Male
  • Middle Aged
  • Palliative Care / economics
  • Palliative Care / organization & administration*
  • Palliative Care / statistics & numerical data
  • Residence Characteristics
  • Severity of Illness Index
  • Sex Factors
  • Socioeconomic Factors
  • Taiwan
  • Terminal Care / economics
  • Terminal Care / organization & administration*
  • Terminal Care / statistics & numerical data

Substances

  • Antineoplastic Agents