Characterizing palliative care utilization among patients with Acute Myeloid Leukemia (AML): Insights from analysis of AML hospitalizations in the United States.

Abstract Introduction Acute Myeloid Leukemia (AML) is an aggressive form of hematological malignancy with an estimated five-year survival rate of 32.9%. Palliative care utilization has been associated with significant improvement in quality of life, psychological distress, and end-of-life outcomes among patients with AML. Limited research is available regarding palliative care use among patients with AML. This study aims to examine differences in patient and hospital characteristics associated with inpatient palliative care utilization among patients with AML. Methods This study utilized the most recent data from the 2022 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database to characterize differences in palliative care utilization among patients with AML. We identified hospitalizations with a diagnosis of acute myeloid leukemia (AML) across all ages using relevant ICD-10-CM diagnostic codes. Patient and hospital characteristics were compared between those who received palliative care and those who did not. Patient-level characteristics included age, sex, race/ethnicity, primary insurance type, and median household income quartile for patient's ZIP code. Hospital characteristics included bed size, location and teaching status. Data analysis was conducted in Stata 19, which included t-test and chi-square test for group comparisons. Results A total of 67,810 hospitalizations for acute myeloid leukemia were identified in 2022. Out of these hospitalizations, the prevalence of inpatient palliative care use was 12.9%. The mean age of hospitalized patients with AML who received palliative care was 67.8 years (95% CI: 66.5–69.2), significantly higher than the mean age of 58.6 years (95% CI: 57.8–59.5) among those who did not receive palliative care. There was no significant sex difference in palliative care use (p = 0.076). Racial differences were observed (p=0.0001). Compared to those who did not receive palliative care, patients who received palliative care were more often White (69.0% vs 74.5%) and less often Black (10.0% vs 7.8%) or Hispanic (8.0% vs 10.7%), while all other race/ethnicity category had similar proportions (10.4% vs 9.7%). Compared to those who did not receive palliative care, patients who received palliative care were more frequently insured by Medicare (48.5% vs 67.1%) and less frequently by Medicaid (13.9% vs 8.0%) or private insurance (35.7% vs 23.0%) (p < 0.0001). Palliative care use did not differ significantly by income quartile (p = 0.779) and hospital bed size (p = 0.902) but was more common in urban teaching hospitals (87.3% vs 9.2% in urban non-teaching and 3.5% in rural hospitals, p = 0.006). Conclusion This study's findings highlight the suboptimal use of inpatient palliative care among patients with acute myeloid leukemia in the analyzed cohort. Despite its known benefits, palliative care was underutilized and varied by age, race/ethnicity, insurance type, hospital location, and teaching status. These findings emphasize the need to better understand and address barriers to palliative care delivery at the patient, provider, and system levels in order to improve access and ensure equitable, high-quality care for patients with AML.