Despite a decrease in the percentage of inpatient deaths over time, more than 40% of patients with multiple myeloma (MM) die in the hospital, with significant transfusion requirements and infections at the end of life, according to a study presented at the 2020 ASH Annual Meeting.
Researchers used data from the National Inpatient Sample (NIS), which includes information on all U.S. inpatient hospitalizations, including primary and secondary diagnoses, procedures, length of stay, and disposition. Researchers tracked hospital admissions for patients with MM and inpatient mortality from 2002 to 2014 via ICD-9 codes.
During this time, the Centers for Disease Control and Prevention and National Cancer Institute reported a total of 144,105 deaths from MM, ranging from 10,913 in 2002 to 12,112 in 2014. The NIS identified a total of 233,932 (non-weighted) hospitalizations for MM during this time.
A total of 14,770 (non-weighted) hospitalizations resulted in death, representing 6.3% of all hospitalizations for MM deaths. A weighted sample of 69,825 hospitalizations resulting in deaths were identified. During the study period, 48.4% of all deaths related to MM in the United States occurred in the hospital, ranging from 5,893 (54%) in 2002 to 5,035 (41.6%) in 2014 (P<0.01).
Receipt of blood transfusions led to death in 35.8% of patients. Infection frequency was identified using the Clinical Classification Software—a tool that allows for clustering patient diagnoses and procedures into clinically meaningful categories. A total of 6,644 infections (45.0%) were identified among the 14,770 (non-weighted) hospitalizations leading to death.
Researchers then analyzed palliative care and hospice involvement during the hospitalization leading to death over time. Palliative care and hospice were consulted in 67 of the 1,260 (non-weighted) hospitalizations in 2002 (5.3%) and in 338 of the 1,007 (non-weighted) hospitalizations in 2014 (33.57%; P<0.01).
Median cost of the hospitalization leading to death increased over time from $48,709 in 2002 to $104,115 in 2014 (P<0.01).
“Our analysis suggests that while palliative care involvement at the end of life has also increased over time, earlier involvement of palliative care and incorporation of transfusion support within hospice services may decrease the number of patients [with MM] dying in the hospital and, therefore, the overall burden and cost of care,” the researchers concluded.
Abbasi S, McClune B, Abdallah AO, et al. Hospitalization at the End of Life in Myeloma Patients: Lessons from the National Inpatient Sample. Abstract 210. Presented at the 62nd American Society of Hematology Annual Meeting & Exposition, Dec. 2-11, 2020.