Health care utilization and end-of-life care for older patients with acute myeloid leukemia.
BACKGROUND
Health care utilization in older adults (age ≥60 years) with acute myeloid leukemia (AML) has not been well studied.


METHODS
We conducted a retrospective analysis of 330 consecutive older patients who were diagnosed with AML between May 1, 2005 and December 23, 2011, at 2 hospitals in Boston to examine their health care utilization and end-of-life care. Using multivariable logistic and linear regression models adjusting for covariates, we also compared health care utilization between patients who received intensive induction chemotherapy (n = 197; cytarabine/ anthracycline combination) versus nonintensive chemotherapy (n = 133; single-agent therapy).


RESULTS
The median number of hospitalizations for the entire cohort was 4.2 (range, 1-18 hospitalizations). Patients who died spent a mean of 28.3% of their life after diagnosis in the hospital and 13.8% of their life attending outpatient clinic appointments. Although the majority of patients (87.9%) died during the 2-year follow-up period, a minority received palliative care (16.2%) or hospice (23.1%) services. Within 30 days of death, 84.5% of patients were hospitalized, and 61% died in the hospital. Among the patients who died, those who received intensive induction therapy (vs nonintensive therapy) spent 30% more of their life after diagnosis in the hospital (P < .0001) and were less likely to receive hospice services (odds ratio, 0.45; P = .05).


CONCLUSIONS
The current findings highlight the intensity of health care utilization among older patients with AML, regardless of treatment modality. Despite the poor prognosis, palliative care and hospice services are rarely used. Future work should study novel health care delivery models to optimize care throughout the course of illness and at the end of life.
Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts.|Dana-Farber Cancer Institute, Center for Outcomes and Policy Research, Harvard Medical School, Boston, Massachusetts.
Areej R
AR
El-Jawahri
Dana-Farber Cancer Institute, Center for Outcomes and Policy Research, Harvard Medical School, Boston, Massachusetts.|Department of Hematological Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts.
Gregory A
GA
Abel
Dana-Farber Cancer Institute, Center for Outcomes and Policy Research, Harvard Medical School, Boston, Massachusetts.|Department of Hematological Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts.
David P
DP
Steensma
Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, North Carolina.
Thomas W
TW
LeBlanc
Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts.|Dana-Farber Cancer Institute, Center for Outcomes and Policy Research, Harvard Medical School, Boston, Massachusetts.
Amir T
AT
Fathi
Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts.|Dana-Farber Cancer Institute, Center for Outcomes and Policy Research, Harvard Medical School, Boston, Massachusetts.
Timothy A
TA
Graubert
Dana-Farber Cancer Institute, Center for Outcomes and Policy Research, Harvard Medical School, Boston, Massachusetts.|Department of Hematological Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts.
Daniel J
DJ
DeAngelo
Dana-Farber Cancer Institute, Center for Outcomes and Policy Research, Harvard Medical School, Boston, Massachusetts.|Department of Hematological Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts.
Martha
M
Wadleigh
Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts.|Dana-Farber Cancer Institute, Center for Outcomes and Policy Research, Harvard Medical School, Boston, Massachusetts.
Karen K
KK
Ballen
Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts.|Dana-Farber Cancer Institute, Center for Outcomes and Policy Research, Harvard Medical School, Boston, Massachusetts.
Julia E
JE
Foster
Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts.|Dana-Farber Cancer Institute, Center for Outcomes and Policy Research, Harvard Medical School, Boston, Massachusetts.
Eyal C
EC
Attar
Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts.|Dana-Farber Cancer Institute, Center for Outcomes and Policy Research, Harvard Medical School, Boston, Massachusetts.
Philip C
PC
Amrein
Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts.|Dana-Farber Cancer Institute, Center for Outcomes and Policy Research, Harvard Medical School, Boston, Massachusetts.
Andrew M
AM
Brunner
Dana-Farber Cancer Institute, Center for Outcomes and Policy Research, Harvard Medical School, Boston, Massachusetts.|Department of Hematological Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts.
Richard M
RM
Stone
Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts.|Dana-Farber Cancer Institute, Center for Outcomes and Policy Research, Harvard Medical School, Boston, Massachusetts.
Jennifer S
JS
Temel
D000368:Aged; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D013727:Terminal Care
acute myeloid leukemia; end-of-life care; health care utilization; palliative care