Early Palliative Care, Goals of Care Conversations and Quality EOL Care in Acute Leukemia and HR-MDS

Context: Patients with acute leukemia frequently receive aggressive treatments near the end of life (EOL). Goals-of-care (GOC) conversations may improve EOL quality, yet few studies have investigated their impact in hematological malignancies. Objectives: To evaluate sociodemographic and clinical factors associated with GOC conversations and the impact of GOC conversations on EOL care. Methods: A retrospective study was conducted among patients with acute leukemia and high-risk myelodysplastic syndromes, treated over a 15-year period at authors' Institution. Results: Of 390 patients, 44.4% had GOC conversations. Palliative care specialists documented the first GOC discussion in 157 patients. One hundred and thirty-three (76.9%) patients received GOC conversations within a program of early palliative care (EPC) . In multivariable analysis, age≥60 (OR: 4.85; 95% CI: 2.18-10.78), ≥2 comorbidities (OR: 2.52; 95% CI: 1.03-6.2), non-White race (OR: 7.97; 95% CI: 1.13-56.32), prior allogeneic transplantation (OR: 8.74; 95% CI: 2.09-36.58), and EPC integration (OR: 16.28; 95% CI: 4.21-62.92) were significantly associated with higher likelihood of GOC discussions. Concerning EOL care, GOC conversations were associated with reduced odds of chemotherapy in the last 90 days (OR: 0.41; 95% CI: 0.21-0.79), ICU admission in the last 30 days (OR: 0.20; 95% CI: 0.05-0.85), and in-hospital death (OR: 0.35; 95% CI: 0.18-0.69) . Conclusions: GOC conversations were infrequently performed and the primary factor that increased their likelihood of occurrence was EPC. When GOC conversations took place, patients experienced higher-quality EOL care. These results support increasing EPC for patients with hematologic malignancies to improve GOC conversations and their overall EOL care and suggest EPC as a prime intervention for trials in this setting.