Dr Thomas LeBlanc: Patients With Blood Cancers Less Likely to Use Hospice Care

Patients with blood cancers tend to use hospice care services less frequently overall than patients with solid tumors. While there has been an increase in hospice care use in patients with blood cancers, there has been a failure to increase hospice use meaningfully, according to Thomas LeBlanc, MD, of the Duke Cancer Institute.

Transcript (slightly modified)

How does hospice use differ between patients with blood cancer and patients with solid tumors?

We know from multiple papers and the literature that patients with blood cancers tend to use hospice care services less frequently overall than patients with solid organ tumors. This is something that’s been shown repeatedly over time and something that we don’t entirely understand but we do have some ideas about in terms of what might be driving this difference. The research that we presented at this years’ ASH Annual Meeting included some evidence that hospice use probably is increasing, actually, in hematology. We looked specifically at Medicare beneficiaries in the SEER data set who have leukemias of various types, so both acute leukemias and chronic leukemias. We saw a significant increase in hospice use between 2001 and 2011 from about 35% in 2001 up to almost 50% in 2011.

Another study presented at this year’s ASH Annual Meeting showed a similar increase in patients with multiple myeloma. However, what were also seeing is a failure to increase hospice use meaningfully, and what I mean by that is patients with hematologic malignancies, when they do use hospice, which again is less frequently than those with solid tumors, tend to use it for a lot shorter period of time. We found an average hospice length of stay of only about 9 days among hematological malignancy patients with leukemias.

More concerning though, we found that those who are dependent on transfusions before hospice referral only used hospice for about 6 days. Those who do hospice care will tell you that using hospice care for just a few hours, or a few days, or even maybe a week or 2 is really not enough to derive the maximal benefits for patients and families when we know that it is really high-quality care for those who are at the end of life who need that care in terms of improving how they feel and their ability to stay at home when their time is short.