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HCRU and End-of-Life Outcomes Among Patients Receiving CAR-T Therapy
Findings from a recent study indicate that intervention may be needed to optimize health care delivery and end-of-life care in patients with hematologic malignancies receiving chimeric antigen receptor T-cell (CAR-T) therapy (J Natl Compr Canc Netw. 2021; 1-7. doi:10.6004/jnccn.2020.7678).
“CAR T-cell therapy has revolutionized the treatment of patients with hematologic malignancies, but it can result in prolonged hospitalizations and serious toxicities,” wrote P. Connor Johnson, MD, Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, and colleagues, adding, “however, data on the impact of CAR T-cell therapy on health care utilization and end-of-life outcomes are lacking.”
This retrospective analysis used electronic health records to identify patients who received CAR-T therapy at 2 tertiary care centers between February 2019 and December 2019. Authors examined data on participants’ hospitalization, receipt of ICU care, and receipt of systemic therapy in the last 30 days of life, palliative care, and hospice referrals.
Of the 236 patients included in this study, 192 (81.4%) received axicabtagene ciloleucel. Among participants, 28.1% were readmitted to a hospital, and 15.5% required admission to the ICU within 3 months of CAR-T therapy.
Among the 84 patients in the deceased cohort, 49 patients (58.3%) were hospitalized with rates of palliative care and hospice referrals at 47.6%, while 26 patients (32.5%) received systemic therapy in the last 30 days of life with rates of palliative care and hospice referrals at 30.9%.
Bridging therapy, hospital admission within 2 months of CAR T-cell infusion and indolent lymphoma transformed to diffuse large B-cell lymphoma increased the likelihood of hospitalization in the last 30 days of life.
“A substantial minority of patients receiving CAR T-cell therapy experienced hospital readmission or ICU utilization in the first 3 months after CAR T-cell therapy, and most deceased recipients of CAR T-cell therapy received intensive EoL [end-of-life] care,” concluded the authors, adding, “these findings underscore the need for interventions to optimize health care delivery and EoL [end-of-life] care for this population.”—Marta Rybczynski
