Heme-hospice: an intervention to improve hospice use for patients with hematologic malignancies

Active Project Grant Awarded Last action

Award ID
R37CA289639
Recipient
Awarding agency
Obligated
$2,106,722

Award facts

Assistance listing
93.393 Cancer Cause and Prevention Research
Completion date 41% complete
Originally
Place of performance
Boston, MA 02215, USA

Award details come from USAspending.gov.

Description

As the agency reported it.

Abstract
HOSPICE is the gold standard of quality end-of-life (EOL) care. As compared to the DE-facto option of dying in a hospital, HOSPICE improves quality of life (QOL), reduces EOL care expenditures, and improves caregiver bereavement outcomes. Although most patients who DIE from cancer receive HOSPICE care, adults with blood cancers are a glaring exception, with less than 25% receiving HOSPICE services. The few who enroll in HOSPICE typically do so in the last few days of life, negating most of its benefits. Lack of access to blood transfusions is the prime barrier to HOSPICE use for this patient population. Refractory anemia and thrombocytopenia are a common final pathway for many blood cancers and cause debilitating fatigue, shortness of breath, and bleeding. Transfusions palliate these symptoms and improve QOL; yet, most hospices do not provide access to transfusions and none provide home transfusions. Faced with the terrible choice of continuing QOL- preserving transfusions or accessing quality home-based HOSPICE care, most patients OPT for ongoing transfusions. As a result, most blood cancer patients ultimately DIE in the hospital, subjected to painful and unnecessary medical interventions, and separated from the home and the people they care most about in life. In response to this great need, we have developed a novel model of HOSPICE care-hematology-modified HOSPICE (HEME-HOSPICE)-with structured input from blood cancer patients, their caregivers, and hematologic oncologists. Through a unique partnership with a large HOSPICE organization and an academic transfusion service, HEME-HOSPICE combines core elements of HOSPICE (e.g., visiting nurses, home health aides, social workers, chaplains) with home transfusions that are triggered by symptoms (e.g., fatigue, shortness of breath, and bleeding) and informed by laboratory parameters. We propose a parallel cluster randomized trial of 350 HOSPICE-eligible adult patients with blood cancers, clustered by hematologic oncologist, to test the efficacy of access to HEME-HOSPICE versus usual care, with the primary outcome of HOSPICE enrollment. Secondary outcomes include length of HOSPICE enrollment, high-intensity healthcare use, expenditures, patient/caregiver- reported QOL and mood, and quality of death. We hypothesize that access to HEME-HOSPICE will result in higher rates of HOSPICE enrollment compared to usual care. We also anticipate that IT will result in a reduction in high-intensity healthcare use near the EOL, lower expenditures, and improved QOL and mood for patients and their caregivers. This application offers the opportunity to rigorously address a critical barrier that results in many patients with blood cancers dying without the benefits of HOSPICE care. Ultimately, this research has the potential to transform HOSPICE care delivery and improve EOL care for blood cancer patients.

Transactions

Action Obligated Date
Amendment $0
Amendment $0
Amendment $0
Amendment $643,670
Amendment $731,526
Original award $731,526

Subawards

Subrecipient Amount Awarded
Brigham & Womens Hospital Inc. Throughout the duration of the project, Richard Kaufman, MD (Site-PI/Co-Investigator) will provide the following in conjunction with the BWH Blood Bank. YEAR 1:… $59,918
Care Dimensions, Inc. Throughout the duration of the project, Caitlin Brennan, PhD, APRN (Site PI/Co-Investigator) will provide the following in conjunction with a HEME-hospice nurse… $144,976
Care Dimensions, Inc. Throughout the duration of the project, Caitlin Brennan, PhD, APRN (Site PI/Co-Investigator) will provide the following in conjunction with a HEME-hospice nurse… $87,040

Quick answers

Who received award R37CA289639?

R37CA289639 was awarded to Dana-Farber Cancer Institute, Inc. by National Cancer Institute (National Institutes of Health) on June 1, 2024.

How much is award R37CA289639 worth?

$2,106,722 has been obligated on R37CA289639.

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