Trends in hospice utilization and place of death preferences in multiple myeloma-related deaths from 2003 to 2020: Analysis of CDC Wonder database.
Authors: Faisal Muhammad Salman , Sukaina Mahnoor , Mishra Rahul , Khosla Atulya Aman , Batra Nitya , Kumar Madhan Srinivasan , Soror Noha , Ahmad Zain Ishtiaq , Jatwani Karan , Anwer Faiz 
Published: June 2024

e24039

Background: Multiple myeloma (MM) is an incurable hematological malignancy of plasma cells with high disease-related morbidity and mortality. Modern treatment has revolutionized the care of MM patients. However, a significant proportion of patients will eventually succumb to the disease. Place of Death (POD) is an important determinant of patient and caregiver preference, access to home-based supportive care, and cost of caregiving at EOL. We evaluate trends in POD for patients and hospice utilization with MM in the U.S. from 2003 to 2020. Methods: We analyzed data using the Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiologic Research) database. The data for deaths due to MM was pooled using the International Classification of Diseases-10th Revision code C 90.0. We included adult patients (age > 18 years), diagnosed with MM during 2003-2020. The demographic data was obtained to calculate descriptive statistics using age, gender, place of death, census region, and utilization of hospice mortality. Annual percentage change (APC) in mortality was calculated using the joinpoint model. Results: There were 205,472 deaths in MM patients in the era 2003-2020, of which 88,245 (42.95%) deaths were in the decedent home and hospice facility (H&H) and107,275 (52.12%) deaths were reported in medical facilities and nursing homes. There was a significant increase in the trend of H&H [29% to 58%, average annual percentage (AAPC) 4.6404, p < 0.001] and a decline in medical facility/nursing home (M&N) deaths [64.9% to 37.7%, AAPC-2.1059, p < 0.001]. When stratified by census regions, all regions in the US depicted significantly increased utilization of H&H (p < 0.001), with the highest H&H utilization in the West region (CENS-R4) of 47.97%, while the highest M&N mortality of 60.4% was observed in North-East region. There is a significant increase in H&H utilization reported in the age group 45-64 years (AAPC 3.544) and age group 65+ (AAPC 5.0277) with p < 0.0001 for both groups. The younger patients (Age < 45) tend to use hospice less, but the number of deaths in the group was small. Furthermore, we saw increased H&H utilization in both genders, with female AAPC at 4.0951 and male AAPC at 5.1393, p < 0.0001 With regards to race, the highest H&H utilization was seen in whites (44.66%), then American Indian or Alaska Native (40.12%), Asian or Pacific Islander (36.76%), and African American (36.05%). However, the trend analysis from 2003-2020 depicts the highest AAPC change in AAPI (8.8409). Conclusions: Over the past two decades, there has been a trend in increased utilization of hospice facilities in end-of-life care among MM patients. However, there is still opportunities to expand its utility especially in the North-East and among African American patients to reduce the psychological and cost of end-of-life care.