Effect of early palliative care integration on healthcare utilization in patients with newly diagnosed multiple myeloma.

Abstract

e24042 Background: Owing to its incurable nature and cumulative toxicities from multiple treatment lines, managing symptoms and complications of multiple myeloma (MM) will inevitably utilize healthcare resources. Early palliative care (PC) integration has been shown to curb the use of resources, especially towards the end of life. It remains unknown whether the same effect is seen in patients with MM. In our previous study of patients with newly diagnosed symptomatic MM (case group), we observed that functional well-being, pain experience and overall quality of life improved with PC involvement within eight weeks of diagnosis. In this study, we compared this cohort to patients who received standard care (control group) to determine the effect of early PC on healthcare utilization. Methods: Using propensity score-matching, control patients were identified by age, gender and Eastern Cooperative Oncology Group (ECOG) score with a 1:2 ratio. Outcome measures included number of emergency room (ER) visits, number of unplanned hospital and intensive care unit (ICU) admissions and number of hospital and ICU days. Data were collected within a year from time of diagnosis. Wilcoxon rank sum test was used to compare outcomes between case and control patients. Results: The case group’s (n=20) median (IQR) age was 65 (60-69.5); 63.5 (57.5-70) for control patients (n=40). In both groups, 75% were female and 55% had an ECOG score of 1. Case group had a median (IQR) of 0 (0-0.5) ER visits, 1.5 (0-11.5) unplanned hospital days and 0 (0-0.5) ICU days, while control group had 0 (0-1), 0 (0-10) and 0 (0-0), respectively. There were no significant differences in ER visits, unplanned hospital admissions, ICU admissions, hospital days and ICU days between groups. Conclusions: Early PC integration did not appear to differ from standard care on healthcare utilization in this small cohort of patients with MM. Future studies should focus on patients further along the trajectory, namely those with relapsed or progressive symptomatic MM. Summary of healthcare resource utilization by case-control status. Healthcare Resource Group N Min 25 th Percentile Median 75 th Percentile Max P-value Number of ER 1 Visits Control 40 0 0 0 1 6 0.69 Case 20 0 0 0 0.5 3 Number of Hospital Admissions Control 40 0 0 2 4 9 0.82 Case 20 0 1 2 2.5 11 Total Number of Hospital Days Control 40 0 0 13 21 53 0.79 Case 20 0 1 9 15.5 32 Number of Unplanned Hospital Admissions Control 40 0 0 0 1 5 0.42 Case 20 0 0 1 2 5 Total Number of Unplanned Hospital Days Control 40 0 0 0 10 38 0.58 Case 20 0 0 1.5 11.5 31 Number of ICU 2 Admissions Control 40 0 0 0 0 2 0.15 Case 20 0 0 0 0.5 1 Total Number of ICU Days Control 40 0 0 0 0 6 0.17 Case 20 0 0 0 0.5 7 1 ER – emergency room; 2 ICU – intensive care unit.