Blood cancer: timely "goals of care" discussion promotes patient QoL

  • Odejide OO & al.
  • Cancer
  • 8 Oct 2019

  • curated by Craig Hicks
  • Univadis Clinical Summaries
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Takeaway

  • Patients with blood cancers who have timely goals of care (GOC) discussions are less likely to experience high-intensity medical care near the end of life (EOL), and are more likely to enroll in hospice.

Why this matters

  • These patients have more near-EOL chemotherapy, acute hospitalizations, and ICU admissions and fewer hospice enrollments than those with solid malignancies.

Study design

  • Researchers analyzed the records of 383 patients (56.1% men, 89.8% white) who died after blood cancer treatment; 70.8% were aged ≥60 years.
  • Funding: None disclosed.

Key results

  • 33.2% of initial GOC discussions occurred >30 days before death, 34.8% occurred in an outpatient setting, and 46.4% included a hematologic oncologist.
  • Lower odds of ICU admission ≤30 days before death were associated with first GOC discussions:
    • >30 days before death (OR, 0.37; 95% CI, 0.17‐0.81).
    • In an outpatient setting (OR, 0.21; 95% CI, 0.09‐0.50).
    • With a hematologic oncologist (OR, 0.40; 95% CI, 0.21‐0.77).
  • Hospice use >3 days before death was associated with discussions including a hematologic oncologist (OR, 3.07; 95% CI, 1.58‐5.96).

Limitations

  • The study was retrospective, single-center, and observational.
  • Unknown effects of GOC discussions on patient/caregiver decision-making.