Association between palliative care consultation and end-of-life care intensity in multiple myeloma.

Abstract

e24062 Background: Multiple myeloma (MM) is characterized by an unpredictable disease course, repeated lines of therapy, and substantial symptom burden, complicating integration of palliative care (PC). Optimal referral timing for PC in MM remains poorly defined. We evaluated the association between PC consultation timing and end-of-life (EOL) care intensity in patients with MM. Methods: A retrospective chart review of adults with MM treated within a single health system was conducted. Only decedents were included for standardized assessment of EOL outcomes. Fifty decedents comprised the final analytic cohort. Diagnosis date was defined as the date of first bone marrow biopsy. Patients were categorized by time from first PC consultation to death as: no PC, ≤30 days, 31–90 days, or >90 days. The primary outcome was an EOL aggressiveness score adapted from established oncology quality metrics. Secondary outcomes included hospitalization, ICU admission, chemotherapy near death, hospice enrollment, and hospice length of stay. Results: Among 50 MM decedents, 18 (36%) did not receive PC consultation. EOL care intensity varied by PC timing, with the lowest aggressiveness observed among patients receiving PC consultation 31–90 days before death. When timing groups were dichotomized, PC consultation occurring more than 30 days before death was associated with fewer hospitalizations in the final 30 days of life and substantially longer hospice length of stay compared with late or no PC. ICU admissions and chemotherapy use near death were lowest in the 31–90 day group. Patients receiving PC more than 90 days before death represented a heterogeneous subgroup with prolonged disease trajectories and ongoing healthcare utilization. Conclusions: In MM, absence of PC consultation or delayed referral is associated with more aggressive EOL care. PC consultation occurring 31–90 days before death was associated with lower care intensity, fewer hospitalizations, and longer hospice engagement. These findings support a disease-specific, trigger-based approach to integrating PC to improve quality of care near the end of life in MM; potential triggers include refractory disease after ≥2 lines of therapy, recurrent hospitalizations, or transfusion dependence. Limitations include the retrospective, single-center design and modest sample size; however, inclusion of only decedents enabled standardized assessment of EOL outcomes. Outcome No PC (n=18) PC ≤30d (n=16) PC 31–90d (n=5) PC >90d (n=11) Aggressiveness score, median (range) 2 (0–5) 2 (1–5) 0 (0–4) 2 (1–5) Aggressiveness ≥3, n (%) 7 (39%) 6 (38%) 1 (20%) 5 (45%) ICU admission ≤30d, n (%) 5 (28%) 4 (25%) 1 (20%) 4 (36%) Hospitalization ≤30d, n (%) 13 (72%) 16 (100%) 2 (40%) 10 (91%) Chemotherapy ≤14d, n (%) 5 (28%) 5 (31%) 0 (0%) 3 (27%) Hospice enrollment, n (%) 5 (28%) 10 (62%) 4 (80%) 2 (18%) Days in hospice, median (range)* 4 (1–105) 3 (2–11) 42 (10–45) 23.5 (2–45)