An Analysis of Advanced Care Planning and End-of-Life Outcomes in Patients Who Received Allo-HCT

A retrospective study presented during the 2021 ASCO Annual Meeting assessed how advanced care planning (ACP) affected end-of-life (EOL) outcomes in patients who underwent allogeneic hematopoietic stem cell transplant (allo-HCT).

Data from 125 deceased adults (median age, 60.7 years) who underwent allo-HCT between December 2015 and December 2019 were analyzed. Summaries were compiled of patient characteristics, the rate of advance directive (AD) completion, palliative care (PC) consultation, and location of EOL.

Two-thirds of patients (n=82) completed ADs, all of which were completed before allo-HCT and were never modified. Among the patients with ADs, 84% said they wanted to avoid life-sustaining treatment if they sustained terminal illness or irreversible coma.

In the overall cohort, just under half of patients (n=58, 46%) consulted PC during the six months before time of death. Most patients died at home with hospice (38%), followed by in the hospital (non-ICU; 30%), in the ICU (20%), and in a hospice facility (10%). Patients with ADs, compared to those without, were more likely to die outside the hospital (53% vs. 44%; P=0.4506). There were no significant predictors of AD or PC consultation in multivariate analysis. In adjusted analyses accounting for age and comorbidity index, patients with an AD, compared to those without, were much more likely to die outside of the ICU (odds ratio, 3.0; 95% confidence interval, 1.2-7.5; P=0.02); this was even more pronounced in patients who had an AD and also received PC consultation at any time.

“Our findings highlight the importance of ACP for EOL outcomes in the allo-HCT population. While the rate of AD completion in our study population is higher than that of prior studies, future prospective studies aimed to improve the rate of ACP are needed,” the researchers concluded.