Health Care Utilization High Among Older Adults With AML

Older adults with acute myeloid leukemia (AML) have a substantial health care burden and high rates of health care utilization even at the end of life, according to the results of a study published recently in Cancer.

Specifically, Areej R. El-Jawahri, MD, of Massachusetts General Hospital, and colleagues found that some of these patients spend as much as 30% of their lives after diagnosis in the hospital or clinic, and are likely to die in the hospital.

“Although older patients with AML who receive intensive induction therapy are more likely to achieve complete remission and to undergo allogeneic HCT, which is a potentially curative therapy for their disease, they are also more likely to spend time in the hospital and to receive aggressive care at the end of life,” wrote El-Jawahri and colleagues. “Clinicians must integrate patients’ prognostic and disease risk stratification, as well as their values, into their recommendation about the optimal therapy for each patient.”

The researchers retrospectively analyzed the records of 300 patients age 60 or older who were diagnosed with AML from 2005 to 2011 at two Boston hospitals. The researchers examined health care utilization and end-of-life care.

On average, patients were hospitalized about four times, with 27.9% of the cohort being admitted to the intensive care unit at some point post-diagnosis. Patients with AML who died spent an average of 28.3% of their life after diagnosis in the hospital and 13.8% of their life attending outpatient clinical appointments.

About 90% of the patients examined in the study died during the 2-year follow-up period. However, the researchers found that only 16.2% received palliative care and 23.1% hospice care services.

“Hospice utilization is associated with improvement in patients’ quality of life and family caregivers’ grief and satisfaction with care,” the researchers wrote. “The absence of a clear transition between the curative and palliative phases of disease for older patients with AML may hamper the receipt of hospice services.”

The average time from palliative care consultation to death was 7 days. Additionally, 61% of patients died in the hospital.

In multivariable analyses, the researchers found that those patients who died who had received intensive induction therapy spent 30% more of their life in the hospital (P < .0001) and were 55% less likely to receive hospice services (P = .05).

“Our results highlight the significant amount of time spent hospitalized or interacting with the health care system after a diagnosis of AML, especially among patients who receive intensive induction therapy,” the researchers wrote. “Although intensive induction offers a minority of patients a potentially curative therapy, patients should also be informed of the likely outcome if a cure is not achieved. This information can enable patients to make decisions that are aligned with their values, and it can be used to design supportive care interventions to improve the quality of life and care of this population.”