End-of-life care for newly diagnosed diffuse large B-cell lymphoma patients with poor survival outcomes.

Abstract

e24032 Background: Despite recent advances in treatment paradigms for diffuse large B-cell lymphoma (DLBCL), a subset of patients (pts) continues to face a poor prognosis, with survival measured in months following diagnosis. Previous reports indicate high rates of hospitalization and intensive care unit utilization amongst aggressive lymphoma pts prior to death (Johnson, Journal of Palliative Medicine 2022), despite evidence suggesting that many cancer pts prioritize spending their final days at home (Fereidouni, Frontiers in Psychology 2021). Limited research exists on these pts' goals of care and circumstances of death. We conducted a single institution analysis to evaluate patterns of care and end of life events for patients who experienced early mortality after DLBCL diagnosis. Methods: We identified adult pts who died within 100 days of DLBCL diagnosis between 2008 and 2023 using the Lymphoma Data Registry at Cleveland Clinic. This survival cutoff reflects prior SEER findings showing untreated pts have a median survival of about 3 months (Diamond, ASH 2022). The analysis included demographics, disease characteristics, treatment details, code status and outcomes such as cause and location of death. Results: Of 462 newly diagnosed DLBCL patients, 84 (18.2%) had early mortality (Table). These pts were predominantly women (55%), white (88% vs. 7.1% black), married (63% vs. 18% single, 15% widowed), and insured by Medicare (69% vs. 22% private, 2.9% Medicaid, 5.9% uninsured). Median age at diagnosis was 74.9 years, with a median survival of 37 days. Before death, most pts were designated to receive Comfort Care (n = 44, 65%), with lower proportions having DNR/DNI status (n = 6, 9.5%) or remaining Full Code (n = 9, 14%). CPR was performed in 6.6% (n = 4) of cases. Pts with poor survival outcomes most often died either in the intensive care unit (n = 19, 29%) or at home with hospice care (n = 19, 29%), followed by inpatient hospice (n = 9, 14%) and home without hospice (n = 7, 11%). Notably, 4.6% (n = 3) of pts died on a regular nursing floor. Conclusions: Our study reveals that pts with poor survival outcomes in DLBCL often have code statuses aligned with their clinical condition, allowing them to avoid interventions with limited meaningful benefit. However, these pts experience aggressive healthcare utilization, including the intensive care unit as their final treatment location and infrequent hospice care independent of setting, which are inconsistent with most cancer pts’ preferences. These findings highlight the importance of balancing the curative potential of DLBCL therapies with their toxicities and the prognosis of untreated disease by transitioning to a palliative approach at the appropriate stage in the clinical course. Characteristic/Outcome % ECOG 0-2 36 ECOG 3-4 38 Stage IV 58 R-IPI Poor 85 Untreated 33 Death due to Sepsis 47 Death due to Tumor Lysis 11 Death due to GIB Bleed 11 Death due to Other Causes 28