You are using an outdated browser. We suggest you update your browser for a better experience. Click here for update.
Close this notification.
Skip to main content Skip to search

Intensive Care Unit (ICU) Admissions and Transfusions in the Last 2 Weeks of Life

Key findings

For people with acute lymphocytic leukemia, acute myeloid leukemia, diffuse large B-cell lymphoma or multiple myeloma, there is a large range in the percentage of patients who were admitted to the intensive care unit (ICU) or received a transfusion during the last 2 weeks of life. This variation is largely due to the complex nature of these hematologic malignancies, as the level of care required varies across disease sub-groups.

Why is this important to Ontarians?

  • People with hematologic malignancies and other complex blood disorders often require blood transfusions as a result of their disease progression or as a result of treatment. Curative treatments such as chemotherapy can also affect the production and maturation of blood cells and result in the need for blood transfusions.1 However, for those who are at the end of life, blood transfusions may not always be appropriate.
  • For many individuals with hematological malignancies and other complex blood disorders, the change in approach from curative treatment to end-of-life care is often sudden because of the aggressive nature of the disease.
  • Further study of these patterns will improve our understanding of how to optimize healthcare settings and resources to provide appropriate care for these patients, including timely access to palliative care services.
  • Cancer patients with progressive illness must have adequate access to the resources and supports they need to live and die in the setting of their choice. Proactive goals of care discussions and earlier access to palliative care services, especially near the end of life, can help mitigate unplanned or unnecessary use of acute care services in hospitals.

For technical information, see:

Report date: August 2020

Data source: Ontario Cancer Registry (OCR), Registered Persons Database (RPDB), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)

Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Report date: August 2020

Data source: Ontario Cancer Registry (OCR), Registered Persons Database (RPDB), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)

Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Report date: August 2020

Data source: Ontario Cancer Registry (OCR), Registered Persons Database (RPDB), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)

Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Report date: August 2020

Data source: Ontario Cancer Registry (OCR), Registered Persons Database (RPDB), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)

Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Report date: August 2020

Data source: Ontario Cancer Registry (OCR), Registered Persons Database (RPDB), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)

Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Report date: August 2020

Data source: Ontario Cancer Registry (OCR), Registered Persons Database (RPDB), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)

Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Data Table 1: Percentage of people with acute leukemia with at least 1 intensive care unit admission in their last 2 weeks of life, 2014 to 2018
Year of Death Percentage of ALL patients with ICU admissions (%) Percentage of AML patients with ICU admissions (%)
2014 (ALL: N=47, AML: N=325) 25.4 23.6
2015 (ALL: N=45, AML: N=308) 31.3 22.3
2016 (ALL: N=55, AML: N=366) 36.4 23.1
2017 (ALL: N=46, AML: N=340) 22.9 21.6
2018 (ALL: N=49, AML: N=325) 41.9 23.6

Abbreviations: ALL – acute lymphoblastic leukemia, AML – acute myeloid leukemia, ICU – intensive care unit
Report date: August 2020
Data source: Ontario Cancer Registry (OCR), Registered Persons Database (RPDB), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)
Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Data Table 2: Percentage of people with acute leukemia with at least 1 transfusion in their last 2 weeks of life, 2014 to 2018
Year of Death Percentage of aLL Patients With Transfusions (%) Percentage of AML Patients With Transfusions (%)
2014 (ALL: N=47, AML: N=325) 50.7 58.6
2015 (ALL: N=45, AML: N=308) 52.2 55.6
2016 (ALL: N=55, AML: N=366) 55.7 55.9
2017 (ALL: N=46, AML: N=340) 47.1 54.3
2018 (ALL: N=49, AML: N=325) 59.5 57.9

Abbreviations: ALL – acute lymphoblastic leukemia, AML – acute myeloid leukemia
Report date: August 2020
Data source: Ontario Cancer Registry (OCR), Registered Persons Database (RPDB), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)
Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Data Table 3: Percentage of people with diffuse large B-cell lymphoma with at least 1 intensive care unit admission in their last 2 weeks of life, 2014 to 2018
Year of Death Percentage of Patients With ICU Admissions
2014 (N=817) 16.9
2015 (N=914) 18.3
2016 (N=844) 18.1
2017 (N=907) 18.5
2018 (N=908) 16

Report date: August 2020
Data source: Ontario Cancer Registry (OCR), Registered Persons Database (RPDB), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)
Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Data Table 4: Percentage of people with diffuse large B-cell lymphoma with at least 1 transfusion in their last 2 weeks of life, 2014 to 2018
Year of Death Percentage of Patients with Transfusions
2014 (N=817) 21.4
2015 (N=914) 23.1
2016 (N=844) 22.3
2017 (N=907) 23.7
2018 (N=908) 19.2

Report date: August 2020
Data source: Ontario Cancer Registry (OCR), Registered Persons Database (RPDB), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)
Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Data Table 5: Percentage of people with multiple myeloma with at least 1 intensive care unit admission in their last 2 weeks of life, 2014 to 2018
Year of Death Percentage of Patients With ICU Admissions
2014 (N=887) 16.2
2015 (N=880) 14.5
2016 (N=937) 16.5
2017 (N=988) 14.4
2018 (N=957) 16.8

Abbreviation: ICU – intensive care unit
Report date: August 2020
Data source: Ontario Cancer Registry (OCR), Registered Persons Database (RPDB), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)
Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Data Table 6: Percentage of people with multiple myeloma with at least 1 transfusion in their last 2 weeks of life, 2014 to 2018
Year of Death Percentage of Patients With Transfusions
2014 (N=887) 30.2
2015 (N=880) 28.3
2016 (N=937) 27
2017 (N=988) 27.7
2018 (N=957) 25.7

Report date: August 2020
Data source: Ontario Cancer Registry (OCR), Registered Persons Database (RPDB), Discharge Abstract Database (DAD), National Ambulatory Care Reporting System (NACRS)
Prepared by: Quality Measurement and Evaluation (QME), Ontario Health (Cancer Care Ontario)

Figure 7. Use of acute care hospital services by acute myeloid leukemia patients in their last 2 weeks of life, 2014 to 2018

Three overlapping circles showing percentages of acute myeloid leukemia patients using services. See figure description for details.

Figure 8. Use of acute care hospital services by multiple myeloma patients in their last 2 weeks of life, 2014 to 2018

Three overlapping circles showing percentages of multiple myeloma patients using services. See figure description for details.


Results

  • From 2014 to 2018, the percentage of people with acute lymphocytic leukemia who had at least 1 intensive care unit admission in the last 2 weeks of life increased from 25% to 42%. Due to the small number of acute lymphocytic leukemia deaths, some variation is expected in this proportion.
  • The percentage of people with acute myeloid leukemia who had at least 1 intensive care unit admission in the last 2 weeks of life remained stable at approximately 24% from 2014 to 2018.
  • From 2014 to 2018, the percentage of people with acute lymphocytic leukemia who had at least 1 transfusion in the last 2 weeks of life varied from 47% (2017) to 60% (2018) with no evident trend. Due to the small number of acute lymphocytic leukemia deaths, some variation is expected in this proportion.
  • The percentage of people with acute myeloid leukemia who had at least 1 transfusion in the last 2 weeks of life remained stable from 2014 to 2018.
  • The percentage of people with diffuse large B-cell lymphoma who had at least 1 intensive care unit admission in the last 2 weeks of life remained stable at around 16% from 2014 to2018. The percentage of those who received at least 1 transfusion remained stable at approximately 20%.
  • The percentage of people with multiple myeloma who had at least 1 intensive care unit admission in the last 2 weeks of life remained stable at around 15% from 2014 to 2018. The percentage of those who received at least 1 transfusion remained stable at approximately 25%.
  • Of people with acute myeloid leukemia, 24% experienced none of the interventions (transfusions, intensive care unit admission, emergency department visit) in their last 2 weeks of life, while 7% required all 3. (Figure 7)
  • Of people with multiple myeloma, 43% experienced none of the interventions (transfusions, intensive care unit admission, emergency department visit) in their last 2 weeks of life, while 4% required all 3. (Figure 8)

Opportunities

  • Due to the nature of their disease, people with acute lymphocytic leukemia and acute myeloid leukemia often need a higher level of care than those with diffuse large B-cell lymphoma and multiple myeloma.
  • Intensive care unit admissions in the last 2 weeks of life may be appropriate for people who have aggressive disease and suffer complications of treatment, including patients who die during active treatment. More data are needed to understand intensive care unit utilization in the last 2 weeks of life.
  • Supporting access to transfusions, even during the palliative phase of a person’s illness, is an important part of care for those with hematologic cancers. There may be opportunity to improve the delivery setting for transfusions at the end of life by offering this service in hospice or at home.

References

  1. Canadian Cancer Society [Internet]. Blood transfusion; 2020 [cited 2020 September 16;[about 9 screens]. Available from: https://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/tests-and-procedures/blood-transfusion/?region=on