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4847 End-of-Life Therapeutic Burden: A Comparative Study of Hematologic and Solid Tumor Malignancies

Program: Oral and Poster Abstracts
Session: 902. Health Services and Quality—Lymphoid Malignancies: Poster III
Hematology Disease Topics & Pathways:
Research, Lymphoid Leukemias, ALL, Hodgkin lymphoma, Acute Myeloid Malignancies, AML, MDS, Lymphomas, non-Hodgkin lymphoma, B Cell lymphoma, Plasma Cell Disorders, CML, T Cell lymphoma, Chronic Myeloid Malignancies, Diseases, indolent lymphoma, aggressive lymphoma, Therapies, Lymphoid Malignancies, Myeloid Malignancies
Monday, December 12, 2022, 6:00 PM-8:00 PM

Rachel Burstein, MD1*, Adir Shaulov2*, Dina Ben Yehuda, MD2*, Boaz Nachmias, MD, PhD3*, Moshe E Gatt4 and Ariel Aviv, MD5,6*

1hadassah hospital, Ramat Hasharon, AL, Israel
2Department of Hematology, Hadassah Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel
3Department of Hematology, Hadassah-Hebrew University Medical Center, Toronto, ON, Canada
4Hadassah University Hospital, Jerusalem, Israel
5Hematology Unit, HaEmek Medical Center, Afula, Israel
6Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel

Background

During the past years substantial progress has been made in the treatment of hematologic malignancies. However, the majority of patients who suffer from a hematologic malignancy live with incurable and symptomatic diseases and eventually die. Therefore, the palliative services have a major role in the treatment of hematological patients.

Objectives

Previous studies have indicated that hematological malignancy (HM) patients receive more aggressive interventions at the end of life, however little is known about the setting in which these aggressive treatments occurred.

Setting/Subjects

In order to shed light on this important subject, we collected data for 200 consecutive patients, 100 solid tumor patients and 100 HM patients treated at a single center in Israel who died over the period from June 1st 2016 to June 1st 2020.

Measurements

We compared cause of death and end-of-life quality indicators between two groups.

Results

HM patients more commonly died from treatment complications in comparison with solid tumor patients (15% vs 1%) and unrelated causes (26% vs 2%, p=0.001). HM patients died more frequently in ICU (14% vs 7%) and the emergency department (9% vs 0%) and less frequently in hospice (9% vs 15%, p=0.005). More HM patients received mechanical ventilation (14% vs 4%, p=0.013), blood units (47% vs 27%, p=0.003) and platelet transfusions (32% vs 7%, p<0.001).

Conclusion

These findings strengthen the existing literature showing more aggressive treatment at end-of-life in HM patients which might be affected by the higher rate of treatment related mortality and prognostic uncertainty in this population.

Disclosures: Nachmias: AbbVie: Consultancy, Honoraria.

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*signifies non-member of ASH