Care For Acute Leukemia Patients Research Articles

Intensive end-of-life care in acute leukemia from a French national hospital database study (2017\u20132018)

BackgroundA better understanding of how the care of acute leukemia patients is managed in the last days of life would help clinicians and health policy makers improve the quality of end-of-life care. This study aimed: (i) to describe the intensity of end-of-life care among patients with acute leukemia who died in the hospital (2017–2018) and (ii) to identify the factors associated with the intensity of end-of-life care.MethodsThis was a retrospective cohort study of decedents based on data from the French national hospital database. The population included patients with acute leukemia who died during a hospital stay between 2017 and 2018, in a palliative care situation (code palliative care Z515 and-or being in a inpatient palliative care support bed during the 3 months preceding death). Intensity end-of-life care was assessed using two endpoints: High intensive end-of-life (HI-EOL: intensive care unit admission, emergency department admission, acute care hospitalization, intravenous chemotherapy) care and most invasive end-of-life (MI-EOL: orotracheal intubation, mechanical ventilation, artificial feeding, cardiopulmonary resuscitation, gastrostomy, or hemodialysis) care. ResultsA total of 3658 patients were included. In the last 30 days of life, 63 and 13% of the patients received HI-EOL care and MI-EOL care, respectively. Being younger, having comorbidities, being care managed in a specialized hospital, and a lower time in a palliative care structure were the main factors associated with HI-EOL.ConclusionsA large majority of French young adults and adults with acute leukemia who died at the hospital experienced high intensity end-of-life care. Identification of factors associated with high-intensity end-of-life care, such as the access to palliative care and specialized cancer center care management, may help to improve end-of-life care quality.

Home Care of Acute Leukemia Patients: From Active Therapy to End-of-Life and Palliative Care. a Three-Year Experience of a Single Centre

▪Purpose:Since July 2012, the Haematological Home Care (HHC) program was activated in our Institution to improve quality of assistance of patients with haematological malignancies, both in the terminal phase of disease and during active chemotherapy.Methods:We conducted a retrospective study to describe the 3-year experience of our HHC program; its efficacy was measured for acute leukaemia patients only analysing number of hospitalizations, number of accesses to the Emergency department and place of death. Our study population was also compared with historical data from a small group of 17 patients with acute leukaemia assisted at home, by their general practitioner, in the previous 3 years, when the HHC program was not available.Results:The study group consisted of 44 patients, 36 of whom (82%) needed a palliative treatment, while 8 (18%) had an ongoing active chemotherapy. The mean number of hospitalizations was 0.64 (range 0-7) per patient and the number of emergency department visits was 0.82 (range 0-4) per patient. Place of death was home environment in 51.4% and hospital in 40.5% of patients.When compared to data of the historical group, HCC program significantly reduced the number of hospitalizations (0.64 vs 2.53 per patient, range 0-9; P 0.001), significantly increased the number of patients who died at home (51.5% vs 6%; P=0.003) and reduced those who died in hospital (40.5% vs 65%; P 0.003).Conclusions:Home care for patients with acute leukaemia is feasible, decreases the number of hospitalizations, and increases the number of patients who die in their own home. DisclosuresLuminari:Servier: Consultancy; Gilead: Consultancy; Celgene: Consultancy; Roche: Consultancy; Sandoz: Consultancy.

Patterns of Venous Thromboembolism Prophylaxis during Inpatient Treatment of Acute Leukemia: Results of a North American Web-Based Survey

On behalf of the ECOG-ACRIN Cancer Research GroupBackground: Venous thromboembolism (VTE) occurs in 2-12% of patients with acute leukemia (AL) despite disease and therapy-associated thrombocytopenia, and can be associated with significant morbidity and mortality. Due to limited high-quality studies, there are no evidence-based guidelines for VTE prophylaxis in this patient population. Based on our experience and the lack of consensus guidelines, we hypothesized that there would be a wide range in provider practice regarding methods of VTE prevention in patients with AL. To determine the current individual practices in North America, we devised a web-based survey of VTE prophylaxis practice among clinicians caring for patients with AL.Methods: An anonymous 19 question web-based survey, approved by the Johns Hopkins Institutional Review Board, was distributed by email to members of the ECOG-ACRIN Cancer Research Group on 10/22/14. Four reminders were sent at two-week intervals with the survey closing on 12/8/14.Results: Of the total 215 respondents, 64 were excluded for the following reasons: 52 did not directly manage medical care of AL patients, 3 referred AL patients to other centers, 5 left blank responses to all questions regarding VTE prophylaxis, 1 was a duplicate entry, and 3 described their position as support or office staff. One hundred fifty-one responses were eligible for analysis, with a response rate of 20.9% among physicians who treated leukemias. One hundred forty-seven were from the United States and 4 from Canada, representing 88 different institutions and 37 states or provinces. Overall, 47% and 45% of providers reported using pharmacologic VTE prophylaxis during induction and consolidation phases, respectively. Among the providers using pharmacologic prophylaxis, 60% designated 50,000/μL as the platelet count threshold below which they would hold prophylaxis and 26% used a platelet count of 30,000/μL. Fewer providers chose a platelet count of 20,000/μL (4%), 75,000/μL (4%), and 100,000/μL (2%). Lastly, 2% held prophylactic anticoagulation only in the setting of an active bleed and 2% reported variable thresholds. Approximately 15% of providers did not utilize any VTE prophylaxis while 36% used mechanical methods and ambulation. Among providers who did not recommend pharmacologic prophylaxis, the most commonly cited reasons were the perceived high risk of bleeding (51%), absence of data supporting use (38%), and perceived low risk of VTE (11%).Conclusions: These results demonstrate wide variation in clinician practice regarding VTE prevention in hospitalized AL patients during induction and consolidation therapy. Our findings emphasize the need to develop standardized, evidence-based guidelines in this at-risk population. VTEvenous thromboembolism, AL: acute leukemia, SC: subcutaneous, TED: thromboembolic deterrant stockings, SCD: sequential compression device [Display omitted] DisclosuresBarbarotta:Celgene, BMS, Novartis: Speakers Bureau. Prebet:CELGENE: Research Funding. Gore:Celgene: Consultancy, Honoraria, Research Funding.

Overall Management, Outcomes and Costs on a 4-Year Period of 21,757 Acute Leukemia (AL) Patients in France. Data Report from the National Health Registry

The aim of this study is to evaluate the management outcomes and hospital costs of acute leukemia (AL) patients over a 4-year period in France using the national Program for a Medicalised Information System (PMSI) database, which records all hospitalisations in the country.We identified patients with AL or another underlying hematologic malignancy prone to transform into AL (e.g. myelodysplastic syndromes) at diagnosis and hospitalized between 2006 and 2012 and retained only incident patients. We used a retrospective cohort approach, with a 5-year follow-up time from index date (i.e. 2008 to 2012), with an additional focus on the autologous and allogeneic stem cell transplanted (SCT) patient populations during the year 2012. Hospital costs calculations were based on the national scale of costs.A total of 21,757 patients were included with 5,655 acute lymphoblastic leukemias (ALL) (26%) and 16,102 acute myelogenous leukemias (AML) at an incidence rate of 4,300 newly diagnosed AL/year. 54.7% were males (57.6% for ALL and 53.7 for AML) with a median age of 18 years (range 0-100, peak between 0-10 years) for ALL and 71 years (range 0-104, peak between 71-80 years) for AML. In 96.7% of the cases patients were hospitalized in a public healthcare hospital. The median duration of the first hospitalization was 7 days (quartiles: 1-29), with an overall death rate during this first hospitalization of 10.5% (4.4% for ALL and 12.6% for AML). Fifty-nine percent of the patients received chemotherapy, (77% for ALL, and 52% for AML); 3,079 (14%) of patients received an autologous or allogeneic stem cell transplantation (SCT) [883 in ALL patients, 2,196 in AML patients]. Among SCT patients, 2,732 (89%) had an allogeneic SCT [774 in ALL patients and 1,958 in AML patients]. Over the 2,732 allogeneic SCT group, 1,243 (45%) suffered from an acute GVHD (55% of ALL patients and 42% of AML patients), and 21% from chronic GVHD (25% of ALL patients and 20% of AML patients).Post SCT transplant survival rates for AML and ALL were 83% and 86% at one year and 55% and 58% at 4 years. Without SCT transplant, survival rates were 40% and 77% at one year and 24% and 70% at 4 years for AML and ALL respectively. The overall survival rates were significantly improved with transplant for AML patients but not for ALL patients at 4 years (see figure 1). [Display omitted] Cost analyses showed an overall median hospitalization cost the first year after diagnosis of 44,453 € for AL (72,360 € for ALL, and 40,477 € for AML), the second year after diagnosis the median overall hospitalization cost for AL was reduced to 2,185 € (6,212 € for ALL and 904 € for AML). The median hospitalization costs of the stay for SCT were 42 068€ for ALL and also 42 068€ for ALM patients, while the cost of allogenic vs. autologous patients was nearly three times higher.In conclusion, this study in an extremely large national cohort illustrates the current characteristics of the care of acute leukemia patients in our country and provides significant information on the economic impact of the hospital care as well as the additional cost of stem cell transplant. DisclosuresNicolini:Novartis: Consultancy. Laurendeau:CEMKA: Employment. Bureau:CEMKA: Employment. Ricci:Wellmera: Employment. Gerbeau:Novartis: Employment. Bouee:CEMKA: Employment.

Palliative care for acute leukemia patients (nursing)

Palliative care for acute leukemia patients (nursing)

Sodium Bicarbonate Solution versus Chlorhexidine Mouthwash in Oral Care of Acute Leukemia Patients Undergoing Induction Chemotherapy: A Randomized Controlled Trial

The objective of this study was to compare the effectiveness of sodium bicarbonate (SB) solution with chlorhexidine (CHX) mouthwash in oral care of acute leukemia patients under induction chemotherapy. Forty-eight patients were randomly selected and assigned to an SB solution group or CHX-based product group according to acute myelogenous leukemia or acute lymphoblastic leukemia. Patients were asked to rinse their mouth four times a day from the day before chemotherapy started until discharge. The World Health Organization mucositis grade, patient-reported Oral Mucositis Daily Questionnaire, and clinical signs associated with infection were assessed on a daily basis. The oral microbial count was assessed on a weekly basis from the 1st day of chemotherapy started to the 28th day or to the day of discharge from the hospital. Of all the patients in the SB group, 25.0% developed ulcerative oral mucositis, whereas 62.5% in the CHX group did. The onset of oral mucositis was later in the SB group than the CHX group. The oral bacterial colonization in the SB group was significantly higher than that in the CHX group, but clinical signs associated with infection did not differ in both groups. As a result of this study, it was found that oral care by SB solution for acute leukemia patients undergoing chemotherapy was an effective intervention to improve oral health.