Page 150 - Haematologica August 2018

O.O. Odejide et al.
health care systems in Europe, where access to transfusion
is available in hospice settings, the relationship we observed between transfusion-dependence and late enroll- ment may not be present. Modifying the current hospice reimbursement structure in the USA to liberalize the use of palliative transfusions would likely improve timely hos- pice use for patients with myeloma and other hematologic cancers. Indeed, in a national survey of hematologic oncol- ogists, the majority reported that they would refer more
patients to hospice if transfusions were readily available.34 Although providing transfusions necessitates additional costs, our finding that hospice enrollment was associated with a 38.8% absolute reduction in receiving any high- cost medically aggressive care at the EOL suggests that this strategy could be overall financially equivalent, at least from the societal perspective.
The lack of access to dialysis services in most hospices may contribute to refusals or delays in enrollment among
Table 4. Univariable analysis of factors associated with receipt of at least one indicator of medically aggressive care at the end of life among entire cohort of myeloma decedents from 2000 to 2013 (n=12,686).
Characteristic
Sex
Age at diagnosis (yrs)
Race
Marital status at diagnosis
Residency
College education (census tract quintile)
Median income (census tract quintile)
Region
Modified Charlson comorbidity score
Time from diagnosis to death
Dialysis-dependent
Transfusion-dependent
Year of death
Male Female 65-69 70-74 75- 79
Received any aggressive care (n=7079)
n (%)
3670 (58.5) 3409 (53.2) 1415 (63.9) 1689 (61.9) 1629 (56.9) 2346 (48.1) 5514 (53.9) 1565 (63.6) 3717 (58.2) 3362 (53.4) 778 (55.1) 6301 (55.9) 1486 (60.1) 1356 (55.1) 1528 (54.7) 1368 (55.2) 1341 (54.1) 1460 (59.4) 1370 (55.4) 1450 (51.9) 1371 (55.3) 1428 (57.6) 1627 (61.9) 1869 (54.6) 917 (54.1) 2666 (54.0) 1776 (41.9) 5303 (62.8) 3135 (60.3) 3944 (52.7) 6026 (53.1) 1053 (78.8) 6338 (53.9) 741 (79.9) 1417 (58.9) 2781(55.1) 2881 (55.1)
Did not receive any aggressive care (n=5607) n (%)
2605 (41.5) 3002 (46.8) 800 (36.1) 1038 (38.1) 1233 (43.1) 2536 (51.9) 4711 (46.1) 896 (36.4) 2673 (41.8) 2934 (46.6) 635 (44.9) 4970 (44.1) 985 (39.9) 1107 (44.9) 1268 (45.3) 1109 (44.8) 1138 (45.9) 999 (40.6) 1102 (44.6) 1346 (48.1) 1107 (44.7) 1053 (42.4) 1002 (38.1) 1557 (45.4) 778 (45.9) 2270 (46.0) 2464 (58.1) 3143 (37.2) 2063 (39.7) 3544 (47.3) 5324 (46.9) 283 (21.2) 5421 (46.1) 186 (20.1) 990 (41.1) 2266 (44.9) 2351 (44.9)
P
<0.001
<0.001
<0.001
<0.001
0.55
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
0.003
≥80 White
Nonwhite
Married
Other Rural Urban
1 (lowest)
2 3
4
5 (highest) 1 (lowest) 2
3
4
5 (highest) Northeast South Midwest West 0-1
2+
< 1 year ≥1year No Yes
No Yes 2000 – 2003 2004 – 2008 2009 – 2013
1386
All percentages are row percentages.
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