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Transfusions in the Last 2 Weeks of Life Methodology

Transfusions in the Last 2 Weeks of Life Methodology
Short description of Indicator Percentage of decedents in each malignant hematology (MH) sub-group (acute lymphoblastic leukemia [ALL], acute myeloid leukemia [AML], diffuse large B-cell lymphoma [DLBCL], multiple myeloma [MM]) who received a transfusion in the last 2 weeks of life
Rationale for measurement Blood transfusions are a particularly important intervention for people with blood cancers. In addition, the last 2 weeks of life is a period of high health care utilization for many decedents (e.g., emergency department visits, hospitalizations).

Little is known about use and appropriateness of transfusion support at end of life in blood cancer patients. For many patients who are designated end of life or palliative prior to death, blood transfusions may be an appropriate component of their care if the transfusions decrease symptoms and maintain the individual’s quality of life. Tracking transfusions may help to identify changes in patterns of care for these end-of-life patients.
Evidence/references for rationale Literature to support this indicator:
  • Ho TH, Barbera L, Saskin R et al. (2014). Trends in aggressiveness of EOL cancer care in the universal health care system of Ontario, Canada. JCO vol 29no. 12 1587-91.
  • Wang, R., Zeidan, A. M., Halene, S., Xu, X., Davidoff, A. J., Huntington, S. F., ... & Ma, X. (2017). Health care use by older adults with acute myeloid leukemia at the end of life. Journal of Clinical Oncology, 35(30), 3417.
  • El‐Jawahri, A. R., Abel, G. A., Steensma, D. P., LeBlanc, T. W., Fathi, A. T., Graubert, T. A., ... & Attar, E. C. (2015). Health care utilization and end‐of‐life care for older patients with acute myeloid leukemia. Cancer, 121(16), 2840-2848.
  • Busemann, C., Jülich, A., Buchhold, B., Schmidt, V., Schneidewind, L., Pink, D., ... & Krüger, W. H. (2017). Clinical course and end-of-life care in patients who have died after allogeneic stem cell transplantation. Journal of Cancer Research and Clinical Oncology, 143(10), 2067-2076.
Calculations for the indicator Decedents with at least 1 blood transfusion in the last 14 days of life / Number of decedents with the specific disease = Percentage of decedents in each malignant hematology sub-group who received a blood transfusion in the last 2 weeks of life.
  • For calendar years 2014 to 2018 (deaths)
  • By type of cancer – acute myeloid leukemia, acute lymphoblastic leukemia, diffuse large B-cell lymphoma, multiple myeloma

Analysis:

  • Cohort: the Registered Persons Database (RPDB) and Ontario Cancer Registry (OCR) databases were used to identify decedents in calendar years 2014 to 2018, and the OCR was used to identify those who were diagnosed with each disease sub-group.
  • Cases were excluded if: 1) the patient did not have a valid health insurance number; or 2) the patient was younger than 18 years of age.
  • Inclusion in the numerator was determined by examining acute discharges using the Discharge Abstract Database (DAD) and the National Ambulatory Care Reporting System (NACRS) in the last 2 weeks of life, and identifying 2 types of transfusions: red blood cells and platelets.
Standardized Rate Calculation N/A
Unit N/A
Data sources
  • Ontario Cancer Registry, Ontario Health (Cancer Care Ontario)
  • Registered Persons Data Base, Ministry of Health
  • Discharge Abstract Database, Canadian Institute for Health Information
  • National Ambulatory Care Reporting System, Canadian Institute for Health Information
Time Frame 2014 to 2018
Geographic Scale Provincial
Denominator description All decedents who were diagnosed with the malignant hematology disease sub-group
Numerator description Decedents who received a blood transfusion in the last 14 days of life
Considerations  N/A
Data availability & limitations
  • Inclusion in the decedent cohort is not limited to those whose cause of death is the cancer in question. As a result, some deaths, and transfusions in the last 2 weeks of life, may be caused by illness or injury not related to malignant hematology cancers.
  • This analysis does not include Ontario cancer patients who died outside of Ontario, as they would not be identified in the administrative data in Ontario.