Can Earlier Use of Palliative Care Improve End-of-Life Outcomes in AML?

Setting up a palliative care consultation program for patients with acute myeloid leukemia (AML) improved some aspects of care.

While earlier palliative care (PC) is associated with an improvement in hospice use and intensive care unit (ICU) utilization, it was not significantly associated with an improvement in end-of-life (EOL) outcomes for patients with acute myeloid leukemia (AML), according to a study published in Journal of Palliative Medicine.

While PC is an “integral component” of quality cancer care, more research is needed to understand the relationship between early PC and EOL outcomes, the authors wrote.

“Data regarding PC for patients with hematologic malignancies (HMs) generally, as well as earlier PC integration into routine care of these patients, are less mature,” they explained. “The role of early PC in HMs has only recently been studied in the clinical setting.”

The study included retrospective data from the Rhode Island Hospital, which embedded a PC service into inpatient malignant hematology service January 2017. Data was obtained from chart reviews and electronic health records between 2015 and 2019 on patients diagnosed with AML.

A total of 139 patients were included in the final analysis. Cohort A included 46 patients prior to the initiation of the embedded PC service and Cohort B included 93 patients after the service was embedded. In Cohort A, 34 patients died compared with 47 in Cohort B.

In general, PC consultation was associated with a significant increase in hospice use and fewer ICU admissions, as well as a trend toward fewer inpatient deaths. Cohort B had significantly higher use of PC consultation (75%) compared with Cohort A (43%; P = .0006). Only 11% of patients in Cohort A had early PC consultation, which increased significantly to 52% in Cohort B.

However, there was no significant improvement EOL quality outcomes between the cohorts or even among patients who received early PC consultation.

“While there was a slight numerical increase in Cohort B in hospice use, a decrease in ICU admission in the last 30 days of life, and a decrease in chemotherapy use in the last 14 days of life, these did not reach statistical significance,” the authors wrote.

They noted that the study might not have identified a benefit for patients receiving early PC consultation because of the limited number of patients who received it and died by the time of the analysis. In addition, they noted that it took time for the cultural shift to occur once the PC service was embedded. During the time of the analysis, not all patients with a new AML diagnosis received a PC consultation.

“With time, this has changed, and it is possible that this analysis would have different results if completed at a later date, with a larger cohort of patients, and a statistical significance between these two groups could be detected,” they wrote.

The single site nature of the analysis was one limitation, as was the lack of standardization of the PC consultation. Some patients in the postanalysis group did not receive the intervention at all.

“The value of early PC in HMs may be better measured using patient-reported outcomes and QOL [quality-of-life] measures rather than established EOL care quality outcomes,” the authors concluded.” Future research is needed to more definitively examine the association between early PC and EOL outcomes in patients with HMs, as well as to directly analyze benefits in patient reported symptoms and QOL metrics.”

Reference

Pelcovits A, Olszewski AJ, Decker D, Guyer D, Leblanc TW, Egan P. Impact of early palliative care on end-of-life outcomes in hematologic malignancies. J Palliat Med. Published online November 25, 2021. doi:10.1089/jpm.2021.0193