title: Intensity of end-of-life care for patients with myelodysplastic syndromes: Findings from a large national database.
abstract: BACKGROUND
  As the population ages, the prevalence of myelodysplastic syndromes (MDS) will increase, and many patients with MDS will require end-of-life (EOL) care. Little is known about the intensity of EOL care received by patients with these malignancies.
  
  
  METHODS
  Using the Surveillance, Epidemiology, and End Results-Medicare database and standard EOL quality measures, we assessed the prevalence and predictors of intensive care unit (ICU) admission in the last 30 days of life, chemotherapy in the last 14 days of life, and hospice enrollment among MDS patients who were 65 years old or older and died between 2006 and 2011.
  
  
  RESULTS
  Of 6,955 patients, 28% were admitted to the ICU and 7% received chemotherapy near the EOL, while 49% enrolled in hospice. In multivariable models, patients dependent on red blood cell or platelet transfusions at the EOL were less likely to enroll in hospice (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.61-0.78). Nonwhite patients were less likely to enroll in hospice (OR, 0.77; 95% CI, 0.67-0.89) and more likely to be admitted to the ICU near the EOL (OR, 1.19; 95% CI, 1.03-1.38). Finally, the prevalence of hospice enrollment increased in later years (P < .001).
  
  
  CONCLUSIONS
  The intensity of EOL care for patients with MDS varies but is potentially suboptimal with respect to the traditional measure of hospice use. The lower odds of enrollment for transfusion-dependent patients suggest that the current hospice model, which largely disallows transfusions, may not be meeting the palliative needs of this population.
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Sean A
authors.initials: SA
authors.lastname: Fletcher
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Angel M
authors.initials: AM
authors.lastname: Cronin
authors.affiliation: Yale Cancer Center, New Haven, Connecticut.
authors.forename: Amer M
authors.initials: AM
authors.lastname: Zeidan
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Oreofe O
authors.initials: OO
authors.lastname: Odejide
authors.affiliation: Yale Cancer Center, New Haven, Connecticut.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Gore
authors.affiliation: Yale Cancer Center, New Haven, Connecticut.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Davidoff
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: David P
authors.initials: DP
authors.lastname: Steensma
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Abel
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D016638:Critical Illness / Q000628:therapy; D016208:Databases, Factual; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016017:Odds Ratio; D010348:Patient Care Team / Q000458:organization & administration; D011787:Quality of Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D018426:SEER Program; D012737:Sex Factors; D016019:Survival Analysis; D013727:Terminal Care / Q000379:methods*; D014481:United States
keywords: end-of-life care; health services; hematologic malignancies; myelodysplastic syndromes; quality