Association of systemic anticancer treatment (SACT) with end-of-life (EOL) healthcare use among older patients with hematologic malignancies.

306 Background: The receipt of SACT at EOL is associated with lower quality of life and higher healthcare use. However, research has focused on solid tumors or predates the advent of new drugs, such as immunotherapy (IO) and targeted therapy (TT). Despite historically intensive EOL care in hematologic cancers, little is known about contemporary patterns with novel therapies. We assessed the association between EOL SACT use and acute care use among older patients with hematologic cancers. Methods: We identified patients 66+ years in SEER-Medicare with 12 months of Part A/B/D coverage who were diagnosed with leukemia, lymphoma, or multiple myeloma 2005-2019 and died 2015-2020. We assessed differences in EOL outcomes (any ER visit, hospitalization, ICU stay, inpatient [IP] death, and hospice use) based on outpatient (OP) and/or inpatient SACT exposure within 30 days of death. We examined rates overall and by OP treatment type using chi-square tests and multivariable regression, adjusting for sociodemographic, comorbidity, and cancer covariates. Results: Among 40701 patients, 17.8% (7235) received SACT within 30 days of death. Compared with no SACT, EOL SACT use was associated with significantly higher rates of ER visits (75.4% vs 56.1%), admissions (80.3 vs 55.6%), ICU use (45.9% vs 27.7%), IP death (50.4% vs 30.6%), and lower rates of hospice (37.3% vs 55.1%) within 30 days of death. In multivariate logistic regression, EOL SACT was associated with higher odds of ER visits (OR [CI], 2.4 [2.2-2.5]), hospitalizations (3.1 [2.9-3.3]), ICU use (2.0 [1.9-2.2]), IP death (2.2 [2.1-2.3]), and lower odds of hospice 0.5 [0.5-0.5]) (all p < 0.001). Among 5711 patients who received OP SACT (14.0%), the use of chemotherapy (CT), IO, TT, CT+IO, and CT+TT were associated with more intensive EOL outcomes compared to no SACT use (p < 0.001). Conclusions: In the era of novel anticancer treatments, SACT use in older patients with hematologic cancers was associated with higher acute care use and lower hospice compared to no EOL SACT use in the last month of life. We assessed SACT and healthcare use without regard to sequence, suggesting that this association is part of a constellation of medicalized EOL care. Treatment Type ER visit Hospitalization ICU Admission IP Death Hospice Use Any IP/OP SACT (N = 7235) 2.4 (2.2-2.5) 3.1 (2.9-3.3) 2.0 (1.9-2.2) 2.2 (2.1-2.3) 0.5 (0.5-0.5) OP CT (N= 1502) 2.2 (2.9-2.5) 2.6 (2.0-2.6) 1.6 (1.4-1.8) 1.7 (1.5-1.9) 0.7 (0.5-0.7) OP IO (N = 459) 2.4 (1.9-3.0) 2.5 (2.0-3.1) 1.7 (1.4-2.0) 1.8 (1.5-2.2) 0.5 (0.4-0.7) OP TT (N = 3067) 2.3 (2.1-2.5) 2.2 (2.1-2.4) 1.8 (1.6-1.9) 1.9 (1.7-2.0) 0.5 (0.4-0.5) OP CT + TT (N = 262) 2.7 (2.0-3.7) 3.3 (2.4-4.5) 2.0 (1.5-2.5) 2.0 (1.5-2.5) 0.6 (0.4-0.7) OP CT + IO (324) 2.4 (1.9-3.1) 2.4 (1.8-3.1) 2.4 (1.9-3.0) 2.6 (2.1-3.2) 0.3 (0.2-0.3) Other OP Combinations (N =97) 1.9 (1.2-2.9) 2.7 (2.0-3.1) 1.4 (1.0-2.2) 2.3 (1.5-3.4) 0.6 (0.4-0.9)