Patrick Connor Johnson, MD, Massachusetts General Hospital, Boston, discusses results from a retrospective analysis evaluating health care resource utilization (HCRU) and end-of-life outcomes among patients with hematologic malignancies receiving CAR-T therapy.
These results were presented at the virtual 62nd American Society of Hematology (ASH) Annual Meeting.
Transcript
My name is Connor Johnson. I'm chief fellow at the Massachusetts General Hospital, Dana-Farber Cancer Institute. It's my great privilege to talk a little bit about some work that our group recently conducted on healthcare utilization and end-of-life outcomes in patients receiving chimeric antigen receptor or CAR T-cell therapy.
A little bit of background on this work is that CAR T-cell therapy, as many know, has completely transformed the treatment landscape for a number of hematologic malignancies, including aggressive B-cell lymphomas.
Despite this, though, CAR T-cell therapy can often have significant toxicities such as cytokine release syndrome or neurotoxicity, and can be associated with significant healthcare utilization due to the need for hospitalization often for CAR T-cell therapy and monitoring for these toxicities.
On top of that, patients can experience prognostic uncertainty because not all patients will unfortunately have a response. Many may go on to progress and ultimately succumb to their disease. Despite this, there's not much known about the healthcare utilization end-of-life outcomes of this unique population, and so we conducted a study.
It was a retrospective analysis to try and understand this better. The retrospective study of a database, that's 2 large academic institutions between 2016 to 2019 of adult patients receiving CAR T-cell therapy, looking at healthcare utilization and end-of-life outcomes.
Some important takeaways from our work that patients in the study of which there were more than 230 predominantly received axicabtagene ciloleucel. About 80% of patients receive that CAR T-cell therapy product, and patients had aggressive B-cell lymphomas. Most patients had a good performance status, and about 40% of patients received bridging therapy.
In terms of the primary outcomes that we assessed in the study from a descriptive standpoint, we found that the median length of stay was about 15 days for CAR T-cell therapy, that 15.5% of patients had an ICU admission within 3 months of CAR T-cell therapy infusion and that about a quarter of patients had a hospital readmission within 2 months of CAR T-cell infusion.
Most of these admissions were relatively early on. The median days from discharged reverse readmission was actually 18 days. In terms of end-of-life outcomes, the majority of patients had a hospitalization within 30 days of death. This is amongst a deceased cohort, which was 84 patients.
About a third of patients have systemic therapy in the last 30 days of life, and about 12% of patients were admitted to the ICU in the last 30 days of life. Less than half of patients had a palliative care consult, and less than a quarter of patients were on hospice for greater than 7 days with about a third receiving hospice services. Only 20% of patients passed away at home.
In addition to this, we looked at factors associated with hospitalization in the last 30 days of life as an important end-of-life metric. This was a logistic regression analysis taking into account multiple variables.
We found that the receipt of bridging therapy as well as the length of stay more than 2 weeks a hospital readmission within 3 months of CAR T-cell therapy and lymphoma subtypes are all associated with a greater likelihood of hospitalization in the last 30 days of life.
Similarly, in a separate multivariable logistic regression analysis found that palliative care was the only factor that was significantly associated with a greater likelihood of hospice referral, again, amongst the deceased patient cohort.
Now, take into account all the limitations of a retrospective study, there's still several important takeaways from this work. Firstly, patients receiving CAR T-cell therapy, at least a significant minority, do experience substantial healthcare utilization. Those at the end of life often experience healthcare utilization as well.
We found that early re-hospitalization may be an important contributor to this patient population's healthcare use with a quarter of patients being re-hospitalized within 3 months of CAR T-cell therapy. I think this may suggest that care transitions work and symptom monitoring interventions could be important targets for future research for a number of different investigators.
In addition, given that palliative care and hospice services were in frequently utilized, studies of early palliative care could be a useful strategy for further investigation in this important and unique patient population.
Finally, we do demonstrate that there are some clinical factors such as the need for bridging therapy that can be associated with a greater likelihood of intensive healthcare use at the end of life. This may be helpful for clinicians or for further research studies to try and identify patients at the highest risk of poor end-of-life outcomes.
Thank you very much.
