title: What is different about patients with hematologic malignancies? A retrospective cohort study of cancer patients referred to a hospice research network.
abstract: BACKGROUND
  Although much is known about solid tumor patients who use hospice, the hematologic malignancies hospice population is inadequately described.
  
  
  OBJECTIVE
  To compare the characteristics and outcomes of hospice patients with hematologic malignancies to those with solid tumors.
  
  
  METHODS
  We extracted electronic patient data (2008-2012) from a large hospice network (Coalition of Hospices Organized to Investigate Comparative Effectiveness) and used bivariate analyses to describe between-group differences.
  
  
  RESULTS
  In total, 48,147 patients with cancer were admitted during the study period; 3518 (7.3%) had a hematologic malignancy. These patients had significantly worse Palliative Performance Scale scores (32% vs. 24% were below 40; P < 0.001) and shorter lengths of stay (median 11 vs. 19 days; P < 0.001). They were more likely to die within 24 hours of hospice enrollment (10.9% vs. 6.8%; odds ratio [OR] 1.66; 95% CI 1.49, 1.86; P < 0.001) or within seven days (36% vs. 25.1%; OR 1.68; 95% CI 1.56, 1.81; P < 0.001) and were more likely to receive hospice services in an inpatient or nursing home setting (OR 1.34; 95% CI 1.16, 1.56 and OR 1.54; 95% CI 1.39, 1.72; both P < 0.001). Among hematologic malignancy patients, those with leukemia had the shortest survival (hazard ratio 1.23; 95% CI 1.13, 1.34; P < 0.001), and 40.3% used hospice for less than seven days (OR 1.31; 95% CI 1.11, 1.56; P = 0.002).
  
  
  CONCLUSIONS
  Hospice patients with hematologic malignancies are more seriously ill at the time of admission, with worse functional status and shorter lengths of stay than other cancer patients. Differences in outcomes suggest the need for targeted interventions to optimize hospice services for the hematologic malignancies population, especially those with leukemia.
authors.affiliation: Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Center for Learning Health Care, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA. Electronic address: thomas.leblanc@duke.edu.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: LeBlanc
authors.affiliation: Division of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA; Center for Learning Health Care, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
authors.affiliation: University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Casarett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019337:Hematologic Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D017051:Hospice Care / Q000706:statistics & numerical data; D006738:Hospices / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data; D016017:Odds Ratio; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Palliative care; comparative effectiveness research; hematologic neoplasms; hospices