1498P - Acute myeloid leukemia: Trends in palliative care utilization in hospitalized patients over 65 years old - A national inpatient sample study (2016-2020)

Background

Acute myeloid leukemia (AML) is a fatal cancer in patients over 65 years old, with a five-year relative survival rate of 10.8%. There is no literature regarding specific determinants of palliative care (PC) utilization in this population. We studied trends and determinants in PC utilization among hospitalized patients using the National Inpatient Sample (NIS).

Methods

This is a retrospective study using NIS data from 2016 to 2020. We included patients aged 65 years or older who were admitted with AML. We identified patients who had an encounter with PC during their hospitalization. The cohort was divided between patients with an encounter with PC and those without. Baseline characteristics were identified and compared between the two groups. Total charges (TC) during hospitalization were measured as an outcome, and then multivariate logistic regression analysis was performed to adjust for confounders.

Results

There were 44,375 patients over 65 years old admitted with AML. Of those, 22% had an encounter with PC. Baseline characteristics and differences between those in which PC was consulted and those in which they were not consulted are depicted in the table. Significant differences were observed in patients who had an encounter with PC, such as higher utilization in the White race (78% vs. 75%). They had higher rates of Heart Failure (HF) (23% vs 17%, p<0.001), acute kidney injury (AKI) (44% vs. 30%, p<0.001), and chronic kidney disease (CKD) (15% vs 12%, p 0.0018) than patients who did not have an encounter with PC. Type of insurance and hospital bed size were not significantly associated with PC utilization. Significantly, PC was consulted less in hospitals in the south region. While adjusting for other confounders, in the multivariate regression analysis, encounters with PC were associated with a decrease in TC during hospitalization of $ 49,047 (p<0.001).

Conclusions

Overall, PC utilization was low. It was reduced in hospitals located in the south region of the USA. It was higher in patients of the White Race and in patients with HF, AKI, and CKD and was associated with decreased cost burden. Our results highlight the need for early palliative care involvement in patients with AML in hospital settings.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.