Timely Hospice Use Increases Among Patients with Myeloma

Hospice use has significantly increased over time among patients with myeloma, which in turn, hopefully highlights the need for timely enrollment, according to a retrospective analysis presented at the 2017 American Society of Hematology Annual Meeting and Exposition.

Timely hospice enrollment helps quality end-of-life care. However, previous research has shown an increase in “late” enrollment — defined as three or more days before death – among patients with blood cancers. “Late hospice enrollment limits the ability of patients and their families to receive the full palliative and supportive benefits of hospice services,” Oreofe O. Odejide, M.D., from Dana-Farber Cancer Institute in Boston, said in an interview with CURE.

Therefore, the researchers characterized hospice use among 12,803 patients with myeloma, in particular on prevalence and predictors of late enrollment. Odejide noted the researchers chose myeloma because of the distinct features associated with the disease compared with other blood cancers.

“For example, myeloma is incurable at diagnosis, there is a very high prevalence of pain among patients with myeloma because of bony involvement by their disease, and there is a high likelihood of renal involvement with possible need for dialysis,” he added. “We felt that these characteristics could potentially impact hospice use, and thus sought to characterize patterns of hospice use and barriers to timely enrollment in this unique population.”

Overall, 47.9 percent of patients enrolled in hospice, with the majority using outpatient/home hospice services (80.5 percent), for approximately 12 days. Among those enrolled, 17.8 percent of patients spend three days or more in hospice.

The researchers found a significant trend toward increased hospice use from 18.6 percent in 2000 to 56.4 percent in 2013, however, they saw no significant increase in late enrollment (from 12 percent to 16.7 percent, respectively). “This suggests that there have been meaningful changes in hospice use for patients with myeloma,” said Odejide. “Distinct features of myeloma such as incurability and high prevalence of pain may make the need for hospice services clearer and encourage timely use.”

In particular, transfusion-dependent patients (37.9 percent) and patients on dialysis (32.9 percent) were more likely to experience late enrollment. Odejide acknowledged this finding suggests that transfusion-dependence is a key barrier to timely enrollment. “The current reimbursement pattern for hospices precludes many hospices from being able to provide transfusions even though they are palliative,” he said. “Policy changes/reimbursement reform that will enable provision of palliative transfusions while enrolled in hospice are thus likely to promote even more timely enrollment for patients with myeloma.”

Lastly, Odejide commended that fact that meaningful progress in hospice use among patients with myeloma has been made, however, more work can be done. “Nonetheless, even though the majority enrolled by 2013, there is still room for additional improvement,” he added. “Accordingly, it is important for health care teams to engage in timely goals of care discussions with patients/families in order to understand and honor preferences regarding hospice care.”