End-of-life care intensity in patients undergoing allogeneic hematopoietic cell transplantation

A population-level analysis

Emily E. Johnston, Lori Muffly, Olga Saynina, Lee M. Sanders, Lisa J. Chamberlain, Elysia Alvarez, Smita Bhatia

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose Intensity of end-of-life care receives much attention in oncology because of concerns that highintensity care is inconsistent with patient goals, leads to worse caregiver outcomes, and is expensive. Little is known about such care in those undergoing allogeneic hematopoietic cell transplantation (HCT), a population at high risk for morbidity and mortality. Patients and Methods We conducted a population-based analysis of patients who died between 2000 and 2013, within 1 year of undergoing an inpatient allogeneic HCT using California administrative data. Previously validated markers of intensity were examined and included: Hospital death, intensive care unit (ICU) admission, and procedures such as intubation and cardiopulmonary resuscitation at end of life. Multivariable logistic regression models determined clinical and sociodemographic factors associated with: Hospital death, a medically intense intervention (ICU admission, cardiopulmonary resuscitation, hemodialysis, intubation), and ≥ two intensity markers. Results Of the 2,135 patients in the study population, 377 were pediatric patients (age≤21 years), 461 were young adults (age 22 to 39 years), and 1,297 were adults (age ≥ 40 years). The most common intensity markers were: Hospital death (83%), ICU admission (49%), and intubation (45%). Medical intensity varied according to age, underlying diagnosis, and presence of comorbidities at time of HCT. Patients with higher-intensity end-of-life care included patients age 15 to 21 years and 30 to 59 years, patients with acute lymphoblastic leukemia, and those with comorbidities at time of HCT. Conclusion Patients dying within 1 year of inpatient allogeneic HCT are receiving medically intense end-of-life care with variations related to age, underlying diagnosis, and presence of comorbidities at time of HCT. Future studies need to determine if these patterns are consistent with patient and family goals.

Original languageEnglish (US)
Pages (from-to)3023-3030
Number of pages8
JournalJournal of Clinical Oncology
Volume36
Issue number30
DOIs
StatePublished - Oct 20 2018

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Terminal Care
Cell Transplantation
Population
Intubation
Intensive Care Units
Comorbidity
Cardiopulmonary Resuscitation
Inpatients
Logistic Models
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Caregivers
Renal Dialysis
Young Adult
Pediatrics
Morbidity

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

End-of-life care intensity in patients undergoing allogeneic hematopoietic cell transplantation : A population-level analysis. / Johnston, Emily E.; Muffly, Lori; Saynina, Olga; Sanders, Lee M.; Chamberlain, Lisa J.; Alvarez, Elysia; Bhatia, Smita.

In: Journal of Clinical Oncology, Vol. 36, No. 30, 20.10.2018, p. 3023-3030.

Research output: Contribution to journalArticle

Johnston, Emily E. ; Muffly, Lori ; Saynina, Olga ; Sanders, Lee M. ; Chamberlain, Lisa J. ; Alvarez, Elysia ; Bhatia, Smita. / End-of-life care intensity in patients undergoing allogeneic hematopoietic cell transplantation : A population-level analysis. In: Journal of Clinical Oncology. 2018 ; Vol. 36, No. 30. pp. 3023-3030.
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abstract = "Purpose Intensity of end-of-life care receives much attention in oncology because of concerns that highintensity care is inconsistent with patient goals, leads to worse caregiver outcomes, and is expensive. Little is known about such care in those undergoing allogeneic hematopoietic cell transplantation (HCT), a population at high risk for morbidity and mortality. Patients and Methods We conducted a population-based analysis of patients who died between 2000 and 2013, within 1 year of undergoing an inpatient allogeneic HCT using California administrative data. Previously validated markers of intensity were examined and included: Hospital death, intensive care unit (ICU) admission, and procedures such as intubation and cardiopulmonary resuscitation at end of life. Multivariable logistic regression models determined clinical and sociodemographic factors associated with: Hospital death, a medically intense intervention (ICU admission, cardiopulmonary resuscitation, hemodialysis, intubation), and ≥ two intensity markers. Results Of the 2,135 patients in the study population, 377 were pediatric patients (age≤21 years), 461 were young adults (age 22 to 39 years), and 1,297 were adults (age ≥ 40 years). The most common intensity markers were: Hospital death (83{\%}), ICU admission (49{\%}), and intubation (45{\%}). Medical intensity varied according to age, underlying diagnosis, and presence of comorbidities at time of HCT. Patients with higher-intensity end-of-life care included patients age 15 to 21 years and 30 to 59 years, patients with acute lymphoblastic leukemia, and those with comorbidities at time of HCT. Conclusion Patients dying within 1 year of inpatient allogeneic HCT are receiving medically intense end-of-life care with variations related to age, underlying diagnosis, and presence of comorbidities at time of HCT. Future studies need to determine if these patterns are consistent with patient and family goals.",
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N2 - Purpose Intensity of end-of-life care receives much attention in oncology because of concerns that highintensity care is inconsistent with patient goals, leads to worse caregiver outcomes, and is expensive. Little is known about such care in those undergoing allogeneic hematopoietic cell transplantation (HCT), a population at high risk for morbidity and mortality. Patients and Methods We conducted a population-based analysis of patients who died between 2000 and 2013, within 1 year of undergoing an inpatient allogeneic HCT using California administrative data. Previously validated markers of intensity were examined and included: Hospital death, intensive care unit (ICU) admission, and procedures such as intubation and cardiopulmonary resuscitation at end of life. Multivariable logistic regression models determined clinical and sociodemographic factors associated with: Hospital death, a medically intense intervention (ICU admission, cardiopulmonary resuscitation, hemodialysis, intubation), and ≥ two intensity markers. Results Of the 2,135 patients in the study population, 377 were pediatric patients (age≤21 years), 461 were young adults (age 22 to 39 years), and 1,297 were adults (age ≥ 40 years). The most common intensity markers were: Hospital death (83%), ICU admission (49%), and intubation (45%). Medical intensity varied according to age, underlying diagnosis, and presence of comorbidities at time of HCT. Patients with higher-intensity end-of-life care included patients age 15 to 21 years and 30 to 59 years, patients with acute lymphoblastic leukemia, and those with comorbidities at time of HCT. Conclusion Patients dying within 1 year of inpatient allogeneic HCT are receiving medically intense end-of-life care with variations related to age, underlying diagnosis, and presence of comorbidities at time of HCT. Future studies need to determine if these patterns are consistent with patient and family goals.

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