A magazine for friends of the Warren Alpert Medical School of Brown University.

Blood or Hospice?


Researchers find some leukemia patients must choose between transfusions or end-of-life care.

Toward the end of life, some leukemia patients depend on blood transfusions to ease their suffering. Unfortunately, the likelihood that transfusions won’t be accessible through hospice care appears to be pose a significant barrier to meaningful use of the Medicare hospice benefit, researchers reported in a new presentation at the American Society of Hematology’s annual meeting in Atlanta on Dec. 9.

Medicare’s hospice benefit provides a flat “per diem” reimbursement for hospice care, which is often not high enough to cover transfusions for leukemia patients. Moreover, few hospices have the capability.

Adam Olszewski, MD, an assistant professor of medicine and a physician at Rhode Island Hospital, and Thomas LeBlanc, MD, an associate professor of medicine at the Duke Cancer Institute, treat patients with blood cancers. They share a mutual frustration that they often can’t connect transfusion-dependent patients with the high-quality, home-based palliative care they need.

They decided to study what was happening nationally. Together with Pamela Egan, MD RES’15 F’19, a hematology/oncology fellow at Brown and Rhode Island Hospital, they analyzed the end-of-life care records of more than 21,000 chronic or acute leukemia patients over age 65 who died between 1996 and 2011.

“We are all working hard trying to make the lives of our patients more meaningful and also help them in the terminal phase of their disease,” Olszewski says.

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