Nationwide trends and disparities in end-of-life care for acute myeloid leukemia: A 2019–2021 NIS analysis of palliative care utilization and hospitalization costs.

Abstract

12064 Background: Acute myeloid leukemia (AML) is a life-threatening hematologic malignancy with high morbidity and mortality, particularly among older adults. Early integration of palliative care (PC) has been shown to improve symptom management, quality of life, and healthcare outcomes in AML patients. However, significant disparities in PC utilization persist, driven by socioeconomic factors such as race, income, and insurance status. This study examines trends in PC use among AML inpatients, focusing on its impact on mortality, hospitalization costs, and complications, while highlighting barriers to equitable care access. Methods: We conducted a retrospective cohort study utilizing the National Inpatient Sample (NIS) database from 2019 to 2021, identifying AML patients via ICD-10 codes, and were classified based on their PC utilization. The Institutional Review Board (IRB) approval was not mandatory since the NIS contains deidentified data. The primary outcome was inpatient mortality, with secondary outcomes including length of stay (LOS), total hospital costs, and key complications. Statistical analysis included t-tests, chi-square tests, and multivariable logistic regression adjusting for demographic, socioeconomic, and hospital factors. Results: A total of 220,790 AML hospitalizations were identified, with 27,540 (12.4%) utilizing PC. PC patients were older (67.41 vs. 58.65 years, p < 0.01) and predominantly White (75.27% vs. 70.70%, p < 0.01). Odds of PC utilization were lower for Black (OR 0.9, p = 0.05), Hispanic (OR 0.7, p < 0.01), and Asian (OR 0.77, p < 0.01) patients. Utilization was highest in urban teaching hospitals (89.2%, p < 0.01) and Medicare patients (OR 1.87, p < 0.01), followed by private insurance (22.99%), Medicaid (8.91%), and self-pay patients (1.38%). Mortality was significantly higher in the PC group (37.4% vs. 4.42%, OR 11.74, p < 0.01). Secondary outcomes included longer stays (12.94 vs. 12.25 days, p < 0.01), higher costs ($214,915 vs. $174,193, p < 0.01), and more complications (tumor lysis syndrome, stroke, thrombocytopenia, sepsis, anemia; all p < 0.01). Conclusions: Palliative care in AML patients was associated with higher mortality, longer hospital stays, increased costs, and complications, likely reflecting its introduction at more advanced stages of the disease. These findings underscore the urgent need for earlier integration of palliative care into treatment protocols. Addressing barriers such as healthcare inequities and improving access to timely interventions could enhance patient quality of life, reduce complications, and optimize resource utilization, ultimately fostering more equitable, efficient, and cost-effective care for AML patients.