Palliative care utilization patterns in chimeric antigen receptor T-cell therapy hospitalizations: A six-year nationwide analysis.

Abstract

e23165 Background: Chimeric antigen receptor (CAR) T-cell therapy is commonly administered with curative intent for hematologic malignancies; however, a subset of patients experiences severe inpatient complications requiring high-acuity care. National patterns of palliative care consultation (PCC) during CAR T-cell therapy hospitalizations and their associations with mortality, goals-of-care decisions, complications, length of stay (LOS), and healthcare costs remain poorly characterized. Methods: We conducted a retrospective cohort study using the Nationwide Inpatient Sample (2017–2022). Adult hospitalizations for acute lymphoblastic leukemia, non-Hodgkin lymphoma (NHL), or multiple myeloma (MM) in which CAR T-cell therapy was administered were identified using ICD-10-PCS codes. PCC was defined using ICD-10-CM diagnosis codes. Survey-weighted analyses generated national estimates. Multivariable logistic and linear regression models assessed associations between PCC and clinical outcomes, adjusting for demographics, comorbidity burden, payer status, and hospital characteristics (two-sided p < 0.05). Results: Among an estimated 5,850 CAR T-cell therapy hospitalizations, 405 (6.9%) involved PCC. Patients receiving PCC were most likely to have NHL (70.4%) followed by MM (21.0%), higher comorbidity burden (Charlson Comorbidity Index > 2: 56.8% vs. 44.8%, p < 0.05), and protein-energy malnutrition (50.6% vs. 16.4%, p < 0.05). There were no differences in age, sex, race, income quartile, or insurance type. PCC independently predicted in-hospital mortality (23.5% vs. 1.1%; adjusted odds ratio [aOR], 32.4; 95% CI, 12.2–85.7) and was strongly associated with Do-Not-Resuscitate status (aOR, 34.5; 95% CI, 13.5–87.7) and discharge to hospice or post-discharge supportive care (aOR, 2.5; 95% CI, 1.4–4.3). PCC was associated with sepsis (aOR, 4.4; 95% CI, 2.1–9.5), acute kidney injury (aOR, 2.0; 95% CI, 1.03–3.72), respiratory failure (aOR, 4.3; 95% CI, 2.2–8.0), shock (aOR, 5.5; 95% CI, 2.7–11.2), mechanical ventilation (aOR, 11.0; 95% CI, 5.4–22.5), renal replacement therapy (aOR, 4.9; 95% CI, 1.4–16.5), and vasopressor use (aOR, 5.1; 95% CI, 2.2–11.9). PCC was associated with longer adjusted LOS (+13.8 days) and higher hospitalization charges (+$584,197; both p < 0.05). No significant associations were observed with cytokine release syndrome or thrombo-hemorrhagic complications. Conclusions: Findings from this nationally representative cohort of CAR T-cell therapy hospitalizations suggest that palliative care involvement reflects clinical severity rather than treatment failure and remains underutilized (6.9%). Furthermore, they align with prior literature supporting earlier integration of palliative care alongside disease-directed therapy to enhance complex inpatient decision-making.