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Reduced transfusion frequency may increase hospice referral in leukemia patients
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ATLANTA — Patients with leukemia are less likely to be referred to hospice toward the end of life than patients with solid tumors, but, according to Michael R. Grunwald, MD, of the Levine Cancer Institute, certain measures could be implemented to increase use of hospice care.
“It has been noted that most patients would prefer to die at home at the end of life, and that perhaps [hematologists and oncologists] could do better at referring patients to hospice toward the end of life,” Grunwald said in an interview.
Grunwald spoke exclusively with HemOnc Today about the results of a population-based study presented by Thomas Leblanc, MD, MA, FAAHPM, assistant professor of medicine at Duke Cancer Institute, and colleagues, at the ASH Annual Meeting and Exposition.
The results add to existing research that has demonstrated that patients with blood cancers use palliative and hospice services at end of life less frequently than those with solid tumors due to transfusion dependence and the inability of hospice organizations to provide life-extending transfusion support.
The study results identified a few “interesting trends,” according to Grunwald.
Hospice use increased by 14% from 2001 to 2011, however patients spent a median of 9 days on hospice. Additionally, patients that were transfusion-dependent spent a median of just 6 days on hospice indicating that transfusion dependence may delay referral to hospice care.
Grunwald highlighted a possible opportunity that could increase hospice referrals at the end of life, and subsequently increase a patient’s satisfaction and reduce cost.
“Perhaps allow hospice patients to receive some amount of palliative transfusions toward the end of life while they are on hospice,” he said. “This might give them a little bit more time at home toward the end of life and increase the proportion of hospice referrals.”
Grunwald said he finds the results clinically relevant because in his practice, both he and his patients are sometimes reluctant to move forward with a hospice referral.
“We don't want to give up transfusions for the last week or two of life, sometimes a little longer than that,” he said. “I think that allowing for some periodic transfusions during that time on hospice might be beneficial for patient satisfaction, patient quality of life, as well as health care resource utilization.”
There could be a challenge, however, with the perceived cost of performing transfusions and having visits to infusion centers while patients are on hospice, he said.
There is a possibility of offering transfusions at a reduced frequency while patients are on hospice.
“While a patient on an aggressive treatment regimen might be coming to our infusion center three times a week for red blood cell and platelet transfusions as needed, perhaps a hospice patient might go on a once a week program where they're coming back periodically to get palliative transfusions.” – by Ryan McDonald
Reference:
Olszewski AJ, et al. Abstract 277. Presented at: ASH Annual Meeting and Exposition; Dec. 9-12, 2017; Atlanta.
Disclosures: Grunwald reports no relevant financial disclosures.