Palliative care and hospice referral were infrequently used to address the end-of-life needs of patients who had received chimeric antigen receptor (CAR) T-cell therapy, according to data presented at December’s American Society of Hematology (ASH) virtual meeting.
In this exclusive MedPage Today video, study author Patrick Connor Johnson, MD, of Massachusetts General Cancer Center in Boston, discusses the findings.
Following is a transcript of his remarks:
My name is Connor Johnson, and I’m from the Massachusetts General Hospital Cancer Center. Very grateful for the chance to talk a little bit about our work examining health care utilization and End of Life (EOL) outcomes in patients receiving chimeric antigen receptor or CAR T-cell therapy.
As a way of some background, CAR T-cell therapy is transforming the treatment landscape of many patients with relapsed or refractory aggressive B-cell non-Hodgkin lymphoma. However, CAR T-cell therapy can be associated with significant and unique toxicity such as cytokine release syndrome or neurotoxicity. In addition to this, patients can experience prognostic uncertainty because some patients will go on to have durable remissions, whereas others unfortunately will progress. Despite this, the health utilization and end of life outcomes of this unique patient population remain unknown. To address this, we conducted a retrospective analysis at two large academic medical centers.
In addition to some descriptive statistics, we then conducted a logistic regression analysis of these patients looking for factors associated with hospitalization in the last 30 days of life, as well as likelihood of hospice referral.
In respect to patients on the study, all patients had to be 18 years of age or older and be treated with chimeric antigen receptor T-cell therapy for a B-cell non-Hodgkin lymphoma at one of two academic institutions over a period of time from approximately 2016 to 2019. In respect to the patients on the study, a few characteristics I want to highlight. About 80% of patients received axicabtagene ciloleucel (axi-cel). That was the predominant CAR T-cell product on study. The most common disease was diffused large B-cell lymphoma or grade three B follicular lymphoma. The median lines of prior treatment was three. About 40% of patients received bridging therapy. And about a quarter of patients had a prior autologous transplant.
In respect to outcomes we examined, we looked at health utilization outcomes as well as end of life outcomes. For health utilization outcomes, immediate length of stay for CAR T-cell therapy infusion on the study was 15 days. About a quarter of patients had a hospital readmission within three months of CAR T-cell therapy infusion, and 15.5% of patients had an ICU admission within three months of CAR T-cell therapy infusion.
In terms of the deceased cohort, which was 84 patients — and I’ll mention that 236 patients were in the full patient cohort. Within that disease cohort important end of life outcomes to highlight are that more than half of patients had a hospitalization in the last 30 days of life, about a third of patients had systemic therapy in the last 30 days of life, and about 12% of patients had an ICU admission in the last 30 days of life. Less than half of patients received a palliative care consultation, less than a third of patients had a hospice referral.
In respect to factors associated with hospitalization in the last 30 days of life, there are a couple of factors I want to highlight from our study. Those included number one, receipt of bridging therapy and number two, some health utilization outcomes, which were length of stay greater than two weeks for CAR T-cell therapy infusion, as well as the hospitalization within three months of CAR T-cell therapy infusion. In respect to factors associated with likelihood of hospice referral, the only factor that was significantly associated with that was palliative care consultation.
So my main takeaways from this work are, first of all, in a subset of patients, health utilization can be significant with CAR T-cell therapy infusion, with about a quarter of patients having hospitalization within three months of CAR T-cell therapy infusion. So future research, I think areas to target include symptom monitoring interventions, as well as transitions of care interventions, given that the period of time after CAR T-cell therapy infusion appears to be at highest risk for intensive healthcare utilization. In respect of end of life outcomes for the deceased cohorts, end the life outcomes included intensive healthcare use in a significant percentage of patients. And given that palliative care consultation and early palliative care referral has been used in other settings, this may be an area ripe for research to look at early palliative care referral in this patient population, in terms of improving end of life outcomes. Thank you so much for your time.