Palliative care involvement in Multiple Myeloma and Association with End of Life Healthcare utilization: Insights from NIS 2023
Patients with multiple myeloma experience high symptom burden and intensive healthcare utilization near the end of life, yet palliative care remains underutilized in this population. Contemporary patterns of inpatient palliative care involvement and their association with end‑of‑life healthcare utilization in multiple myeloma at the national level are not well described.
Materials and Methods/Case Presentation/Objective:
A retrospective review of NIS data 2023 was perfomed to collect the data. Adults older than 18 years old with MM were isolated using ICD-10 codes. Primary outcomes were palliative consultation, ICU admission, discharge disposition. Secondary outcomes include, Length of stay (LOS), hospitalization charges, insurance status. Demographics such as gender, age, ethnicity were also isolated. Statistical analysis such as linear regression, chi squared test were used to analyze the data.
Results/Description/Main Outcome Measure(s):
In 2023, there were an estimated 25,426 weighted hospitalizations involving adults with MM in the United States. The mean age was 72 years old, 44.5% were female, and 55.53% male. 14.7% of MM admission required ICU level care for Acute Respiratory failure. Palliative care consultations occurred in only 19.13% of ICU hospitalizations. Overall in‑hospital mortality was 15.4%, with higher crude mortality among patients with palliative care ([46]% vs [8]%). Mean LOS was 10 days for patients with palliative care consultation p=0 CI 95% (CI 9.8-10.6) and 7 days for without palliative care, p=0 (CI 95% (7.16-7.35)). The mean total costs for patients with MM not receiving PCC during hospital stay $131986.5 vs $167610.1with PPC. Discharge disposition of MM patients with PCC that were discharged/ transferred to a home health facility 26.56%, transferred to skilled nursing facilities, long term facilities 26.77%, discharged home 17%, 26.88% expired. Discharge disposition of MM patient without PCC were 56.78% discharged home, 20.78% to home health care, 17.22% to transferred to skilled nursing facilities, long term facilities, 2.03% expired. However MM receiving PCC was mostly concentrated in urban teaching hospitals 84.39%, urban non- teaching hospital 11.01%, rural 4.61%; p=.04.
Conclusion(s).:
In this national sample of adults hospitalized with MM, in‑hospital mortality and resource use remained substantial, while palliative care consultations were infrequent relative to the high burden of serious illness. These findings highlight opportunities to expand inpatient palliative care and to address disparities in outcomes by race and insurance status.
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