Factors Associated with Palliative Care Utilization Among Patients with Post-Transplant Lymphoproliferative Disease. a Retrospective Analysis of the National Inpatient Sample Database

Introduction: Post-transplant Lymphoproliferative Disease (PTLD) is a major sequela of solid organ or hematopoietic stem cell transplantation, characterized by uncontrolled and erratic proliferation of lymphoid cells. The integration of palliative care, which focuses on symptom alleviation, psychosocial support, and overall quality of life over life prolonging measures is essential in the overall care of these patients. Despite its importance, the determinants of palliative care uptake in PTLD remain unclear. This study aims to elucidate the factors influencing the acceptance of palliative care by patients diagnosed with PTLD.

Methods: We conducted a retrospective analysis of the Nationwide inpatient sample (NIS) database from 2016 to 2020. Our study sample were patients diagnosed with PTLD identified based on International Classification of Diseases, tenth Revision (ICD-10) codes (D47). The exposure variables examined included age, sex (male and female), race (White, Black, Hispanic and others), hospital region (Northeast, Midwest, South and West), Charleson comorbidity index (CCI), length of hospital stay, and insurance type (private, Medicare and Medicaid). Descriptive analysis was employed to characterize these sociodemographic variables within the study sample. Logistic regression analysis was the utilized to assess the factors associated with use of palliative care services among patients with PTLD.

Results: Of the 3,287 patients diagnosed with PTLD, the majority were older than 59 years (35.9%), female (59.9%), and had Medicare insurance (42.7%). The analysis revealed that the likelihood of accepting palliative care increases with age. Patients aged 20-39 years were more than twice as likely to use palliative care compared to those younger than 20 years (aOR 2.2; 95% CI 1.111-4.417). This odd was three times higher for those aged 40- 49 (3.06; 95% CI 1.4 -6.08) and four times higher for those older than 59 years (aOR 3.6; 95% CI 1.82- 7.30) compared to those younger than 20 years of age. The associations of number of comorbidities as measured by the CCI (aOR 1.07; 95%CI 1.01 – 1.14) and length of hospital stay (aOR 1.02; 95%CI 1.01 – 1.03) with palliative care utilization among patients with PTLD were both statistically significant. There were no significant associations found between the use of palliative care and sex, ethnicity, insurance type or hospital regions in the United States.

Conclusions: This study underscores the significant impact of age, comorbidity burden, and length of hospital stay on the utilization of palliative care services among patients with post-transplant lymphoproliferative disease. Our findings indicate that older patients, those with a higher number of comorbidities, and those experiencing prolonged hospital stays are more likely to engage in palliative care. No significant associations were observed with sex, ethnicity, insurance type, or hospital region. These insights suggest a need for targeted strategies to enhance the adoption of palliative care among younger patients, thereby potentially improving the overall acceptance and integration of palliative care when necessary.