Dr Thomas LeBlanc on Improving End-of-Life Outcomes for Patients With Blood Cancer

Thomas LeBlanc, MD, Duke Cancer Institute, addresses the ways palliative care and hospice can improve end-of-life outcomes for patients with blood cancers.


How can improving palliative care and hospice use among patients with blood cancers improve their end-of-life outcomes?

We know that there’s a very clear relationship between receipt of hospice care services at the end of life and quality of end-of-life care. If you look at the national quality forum, there’s several metrics that they pose to measure the quality of care at the end of life and these are applied to all patients with cancer. It’s a yard stick by which we are held basically to measure and attest to the quality of care we are providing among those who die of their disease. When you look at patients with blood cancers compared to those with solid organ tumors, they unfortunately do much worse across all of these end-of-life quality measures. These include things like receipt of chemotherapy in the last two weeks of life, dying in the hospital, spending time in the emergency department in the last month or so of life, utilization of intensive care unit services, things like that, where if you ask an average person and they’d say, "if my time was short I’d really rather be at home, I don’t wanna be in the hospital, I’d rather die at home," and so on.

We know that blood cancer patients do worse in that regard. Some of the data that we presented at this year’s national meeting at the Medicare analysis of leukemia patients shows very clearly that those patients with leukemias in the US who use hospice care services perform dramatically better on all those national quality forum end-of-life measures so they’re far less likely to die in the hospital. They’re much less likely to receive chemotherapy in the last few weeks of life, spend time in the intensive care unit and so on.
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