Receipt of specialized palliative care and health care utilization at the end of life in hematological cancer patients – the Stockholm experience
Background: The treatments of hematological malignancies tend to be intense, and compared with solid tumors, less is known about the health care consumption during end of life (EOL). Therefore, the aim was to study the receipt of specialized palliative care (SPC) and how it affects health care utili...
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| Language: | English |
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Medical Journals Sweden
2025-02-01
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| Series: | Acta Oncologica |
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| Online Access: | https://medicaljournalssweden.se/actaoncologica/article/view/42189 |
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| author | Lena von Bahr Peter Strang Torbjörn Schultz Per Fürst |
| author_facet | Lena von Bahr Peter Strang Torbjörn Schultz Per Fürst |
| author_sort | Lena von Bahr |
| collection | DOAJ |
| description | Background: The treatments of hematological malignancies tend to be intense, and compared with solid tumors, less is known about the health care consumption during end of life (EOL). Therefore, the aim was to study the receipt of specialized palliative care (SPC) and how it affects health care utilization, in relation to sex, age, socioeconomics, and frailty risk (Hospital Frailty Risk Score [HFRS]).
Methods: In a retrospective, observational registry study, all patients who died of a hematological malignancy during the years 2015–2021 in the Stockholm County were included and analyzed with descriptive statistics and logistic regression models.
Results: Of the 2,858 included patients (mean age 76 years, 41% women), 38% had myeloid malignancies, 41% lymphocytic malignancies, and 21% had myeloma. During the last 3 months of life, 56% received SPC, with an overrepresentation of women, aOR 1.35 (1.16–1.58, p < 0.0001), whereas persons with risk of frailty (HFRS) were underrepresented, aOR 0.74 (0.63–0.86, p < 0.0001). Unplanned ER visits were more likely in persons aged over 80 years (p = 0.004) and in persons with frailty risk (p < 0.0001). Patients receiving SPC had a substantially reduced likelihood of ER visits, aOR 0.34 (0.29–0.40, p < 0.0001). Emergency hospitals as place of death was positively associated with frailty risk, aOR 1.50 (1.23–1.83, p < 0.0001) but negatively associated with age over 80 years (p < 0.0001) and especially with receipt of SPC, aOR 0.05 (0.04–0.06, p < 0.0001).
Interpretation: Receipt of SPC could possibly reduce the need for emergency care in the end of life and the Stockholm model might facilitate referral to SPC for hematological patients.
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| format | Article |
| id | doaj-art-8190680d43e546b3974116481498352a |
| institution | Kabale University |
| issn | 1651-226X |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Medical Journals Sweden |
| record_format | Article |
| series | Acta Oncologica |
| spelling | doaj-art-8190680d43e546b3974116481498352a2025-02-11T06:54:50ZengMedical Journals SwedenActa Oncologica1651-226X2025-02-016410.2340/1651-226X.2025.42189Receipt of specialized palliative care and health care utilization at the end of life in hematological cancer patients – the Stockholm experienceLena von Bahr0https://orcid.org/0009-0003-5026-8195Peter Strang1Torbjörn Schultz2Per Fürst3Department of Medicine, Sahlgrenska Academy, Gothenburg University, Sweden; Section of hematology and coagulation, Sahlgrenska University Hospital, Gothenburg, SwedenDepartment of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Research Department Palliative Care, Stockholm Sjukhem Foundation, Stockholm, SwedenResearch Department Palliative Care, Stockholm Sjukhem Foundation, Stockholm, SwedenResearch Department Palliative Care, Stockholm Sjukhem Foundation, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, SwedenBackground: The treatments of hematological malignancies tend to be intense, and compared with solid tumors, less is known about the health care consumption during end of life (EOL). Therefore, the aim was to study the receipt of specialized palliative care (SPC) and how it affects health care utilization, in relation to sex, age, socioeconomics, and frailty risk (Hospital Frailty Risk Score [HFRS]). Methods: In a retrospective, observational registry study, all patients who died of a hematological malignancy during the years 2015–2021 in the Stockholm County were included and analyzed with descriptive statistics and logistic regression models. Results: Of the 2,858 included patients (mean age 76 years, 41% women), 38% had myeloid malignancies, 41% lymphocytic malignancies, and 21% had myeloma. During the last 3 months of life, 56% received SPC, with an overrepresentation of women, aOR 1.35 (1.16–1.58, p < 0.0001), whereas persons with risk of frailty (HFRS) were underrepresented, aOR 0.74 (0.63–0.86, p < 0.0001). Unplanned ER visits were more likely in persons aged over 80 years (p = 0.004) and in persons with frailty risk (p < 0.0001). Patients receiving SPC had a substantially reduced likelihood of ER visits, aOR 0.34 (0.29–0.40, p < 0.0001). Emergency hospitals as place of death was positively associated with frailty risk, aOR 1.50 (1.23–1.83, p < 0.0001) but negatively associated with age over 80 years (p < 0.0001) and especially with receipt of SPC, aOR 0.05 (0.04–0.06, p < 0.0001). Interpretation: Receipt of SPC could possibly reduce the need for emergency care in the end of life and the Stockholm model might facilitate referral to SPC for hematological patients. https://medicaljournalssweden.se/actaoncologica/article/view/42189Observational studyOncologyhealth care utilisationEnd of life careemergency room visitsquality indicators |
| spellingShingle | Lena von Bahr Peter Strang Torbjörn Schultz Per Fürst Receipt of specialized palliative care and health care utilization at the end of life in hematological cancer patients – the Stockholm experience Acta Oncologica Observational study Oncology health care utilisation End of life care emergency room visits quality indicators |
| title | Receipt of specialized palliative care and health care utilization at the end of life in hematological cancer patients – the Stockholm experience |
| title_full | Receipt of specialized palliative care and health care utilization at the end of life in hematological cancer patients – the Stockholm experience |
| title_fullStr | Receipt of specialized palliative care and health care utilization at the end of life in hematological cancer patients – the Stockholm experience |
| title_full_unstemmed | Receipt of specialized palliative care and health care utilization at the end of life in hematological cancer patients – the Stockholm experience |
| title_short | Receipt of specialized palliative care and health care utilization at the end of life in hematological cancer patients – the Stockholm experience |
| title_sort | receipt of specialized palliative care and health care utilization at the end of life in hematological cancer patients the stockholm experience |
| topic | Observational study Oncology health care utilisation End of life care emergency room visits quality indicators |
| url | https://medicaljournalssweden.se/actaoncologica/article/view/42189 |
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