Temporal trends and determinants of inpatient palliative care utilization among hospitalized patients with acute myeloid leukemia: a retrospective cross-sectional study

Background: Acute myeloid leukemia (AML) remains an aggressive malignancy, despite advancements in diagnosis and treatment. Early integration of palliative care has been shown to alleviate symptom burden and enhance quality of life among patients and their caregivers. However, palliative care remains underutilized, especially in hematologic malignancies. This study aims to determine the rate of inpatient palliative care utilization among hospitalized patients with AML and to identify predictors of inpatient palliative care utilization. Methods: This retrospective study utilized data extracted from the National Inpatient Sample database from 2016 to 2020. Adult patients diagnosed with acute myeloid leukemia (AML) and recipients of palliative care services were identified through the International Classification of Diseases, 10th Revision (ICD-10) coding system. Sociodemographic, hospital-related, and clinical characteristics were summarized using frequencies and percentages. Binary logistic regression analysis was performed to determine independent predictors of inpatient palliative care utilization. Results: There were 121,892 hospital admissions of patients with a primary diagnosis of AML. Of these, 460 patients (0.3%) received inpatient palliative care services. Among those receiving palliative care, most were aged ≥ 65 years (59.8%), male (53.3%), White (83.1%), and privately insured (40.2%). In multivariable analysis, older age (OR 1.57; 95% CI 1.23–2.01; p < 0.001), private insurance (OR 1.43; 95% CI 1.33–1.53; p < 0.001), receipt of chemotherapy or stem cell therapy (OR 4.13; 95% CI 3.28–5.20; p < 0.001), and inpatient mortality (OR 8.80; 95% CI 6.86–11.28; p < 0.001) were independently associated with increased palliative care utilization. While non-White race (OR 0.70; 95% CI 0.61–0.81; p < 0.001), treatment in certain hospital regions (OR 0.75; 95% CI 0.67–0.83; p < 0.001), and shorter length of stay (OR 0.60; 95% CI 0.47–0.76; p < 0.001) were associated with lower utilization. Conclusion: Inpatient palliative care remains markedly underutilized among patients with acute myeloid leukemia. Sociodemographic, economic, hospital, and clinical factors significantly influence its utilization. Addressing these disparities through targeted interventions and institutional policies may enhance palliative care integration, potentially improving symptom management, quality of life, and overall care outcomes for patients with AML.