Catching Up With First-Time Attendees
CLINICAL NEWS
On Location ASH Annual Meeting
Catching Up With First-Time Attendees
Rahul S . Vedula , MD Second-year fellow Dana-Farber / Partners CancerCare Program Boston , MA
Kelly Schoenbeck , MD First-year fellow University of California , San Francisco
Last month , we introduced you to two first-time ASH annual meeting attendees : Kelly Schoenbeck , MD , and Rahul Vedula , MD . We checked in with them to see how it went and what they learned in Atlanta .
received palliative care services delivered through an unknown modality .
Use of palliative care was significantly , and inversely , associated with length of survival . Overall palliative care use decreased as survival duration increased , from 7.2 percent in the those with less than six months survival to 2.9 percent in those with > 60 months ( p < 0.001 ).
Compared with patients diagnosed between 2004 and 2005 , those diagnosed between 2012 and 2013 had significantly higher incidence of palliative care use when survival was less than six months ( odds ratio [ OR ] = 1.28 ; 95 % CI 1.17-1.39 ; p value not provided ); this difference in palliative care use was not observed among patients with longer survival , though .
Palliative care was used most often among patients with MM ( OR = 2.65-59.56 ; reference = AML ) and used least among those with CLL ( OR = 0.51-2.94 ; reference = AML ).
Palliative care use did not appear to be affected by sex , location of residence , or distance from the treating facility for any survival groups . The only geographic influence appeared in patients with less than six months survival . In that group , palliative care use was higher in Mountain ( OR = 1.44 ; 95 % CI 1.27-1.64 ) and Pacific ( OR = 1.19 ; 95 % CI 1.09-1.32 ) regions , compared with those on the east coast .
The researchers identified several other factors associated with greater likelihood of receiving palliative care in certain survival groups , including :
• increasing age ( p < 0.001 ; only in people with < 6-month survival and 6- to 24-month survival )
• heavier symptom burden , measured by Charlson Comorbidity Index score ( p < 0.001 ; only in people with < 6-month survival )
• higher literacy level ( p < 0.001 ; only in people with < 6-month survival )
• higher median patient income ( p = 0.011 ; no clear trend according to survival category )
Attendees browse the poster hall at the 2017 ASH Annual Meeting .
Race / ethnicity also affected use of palliative care , but only among those who survived less than six months , with less use among non-Hispanic African Americans ( OR = 0.90 ; 95 % CI 0.82-0.98 ; p value not reported ), compared with non-Hispanic whites . However , Hispanics had an increased use of palliative care among those with longer than 60-month survival ( OR = 1.7 ; 95 % CI 1.09-2.63 ; p value not reported ).
Insurance status only affected rates of palliative care use in those surviving six to 24 months . Compared with those with private insurance , patients with “ other government ” payer insurance were more likely to receive palliative care ( OR = 1.82 ; 95 % CI 1.32-2.50 ; p value not reported ).
In a surprising finding , compared with treatment at a non-academic cancer program , treatment at an academic / research program was associated with lower likelihood of palliative care use , in both those surviving 24 to 60 months ( OR = 0.85 ; 95 % CI 0.76-0.94 ; p value not reported ) and more than 60 months ( OR = 0.74 ; 95 % CI 0.61-0.89 ; p value not reported ). Again , though , there were no clear relationships across survival categories , with little difference in those surviving less than six months ( OR = 1.06 ; 95 % CI 1.00-1.12 ; p value not reported ) or six to 24 months ( OR = 1.0 ; 95 % CI 0.92-1.08 ; p value not reported ).
“ Despite national guidelines and near-universal recommendations , overall [ use ] of palliative care was dismal and [ even lower ] in academic cancer programs , including National Cancer Institute – designated centers ,” the researchers concluded .
Though this was a large study , the findings were potentially limited by the variability in data collected through the NCDB .
The authors report financial relationships with Novartis , Pharmacyclics , Amgen , and Takeda .
REFERENCE
Ailawadhi S , Frank RD , Chimato NT , et al . Utilization of palliative care among patients with hematologic malignancies : an extensive national analysis to define trends and patterns . Abstract # 2107 . Presented at the 2017 American Society of Hematology Annual Meeting , December 9 , 2017 , Atlanta , GA .
What were your overall thoughts and impressions of the meeting ? Were you surprised by anything ? Dr . Schoenbeck : The meeting was a fantastic experience . It was inspiring to meet hematologists from all over the world , and the size of the conference just reinforced that there are a lot of people doing exciting work in hematology . I was certainly surprised by the snow and ice !
Dr . Vedula : The meeting was an amazing learning environment and a lot of fun . Seeing the breadth of presentations and talks – from basic science to clinical trials – made me appreciate even more the amazing work hematologists are doing from all different angles around the world . I was a bit surprised by the sheer volume of content in parallel sessions , which was overwhelming at times . This obviously made it challenging to attend all the sessions I would have liked to . I ended up focusing more on my own clinical and research interests as far as oral abstract sessions , and coupled that with educational programs from other fields .
What are your three takeaways ? Dr . Schoenbeck : Stay for the “ Best of ASH ” session on the last day , be selective about what sessions or activities to attend , and try to stay at a hotel close to the convention center .
Dr . Vedula : Plan and map the sessions out ahead of time using the app ; don ’ t stress about seeing everything , because it ’ s impossible ; and hematology is fun , exciting , and changing rapidly .
Will you attend the 2018 meeting ? Dr . Schoenbeck : Absolutely !
Dr . Vedula : Yes ! Absolutely ! ●
34 ASH Clinical News January 2018 Annual Meeting Edition