Palliative care and hospice utilization in patients with relapsed or refractory diffuse large B-cell lymphoma in the era of CART and novel immunotherapies.

Chimeric antigen receptor T-cell therapy (CART) has changed treatment for relapsed/refractory diffuse large B-cell lymphoma (r/r DLBCL), but most patients still die of their disease and may benefit from palliative care (PC) or hospice services. Whether CART availability has affected PC or hospice referral patterns and end-of-life outcomes remains unclear. We conducted a single-center retrospective study for deceased patients with r/r DLBCL to evaluate PC and hospice utilization before and after CART introduction (87 pre-CART, 95 post-CART). PC referral rates were similar between eras (57.5% vs 70.5%, p = 0.39), as were hospice referrals (79.3% vs 83.2%, p = 0.78). However, patients in the post-CART era had shorter time from last treatment to death (95 vs 51 days, p = 0.001), higher hospitalization rates in the last 30 days of life (57.5% vs 72.6%, p = 0.03), and more in-hospital deaths (19.5% vs 33.7%, p = 0.045). Overall, 20-30% of patients were never referred to PC or hospice.