Patients with hematological malignancies (HMs) have less access to palliative care (PC) than other patients with cancer and benefit from it later on in the course of their disease, although symptom burden is just as heavy. [1][2][3][4] We created a specialized outpatient PC consultation in the hematology department to improve the quality of patient management and enhance cooperation with hematologists. We found that although patient characteristics and survival were extremely variable, they all had in common a need for symptom management and care coordination. As a result of the consultation, hematology teams called upon a specialized PC multidisciplinary team more often to meet patients hospitalized within their departments, and more patients with HMs were hospitalized in PC units.Recent evidence has demonstrated the feasibility, acceptability, and efficacy of integrating PC to improve the quality of life and care of patients with HMs and their caregivers. [5][6][7] Despite clear recommendations to integrate PC in oncology, and in particular, hematooncology, the question of what, when, and how to integrate it has yet to be answered. 8 The constructs of integration plans are needed, adapted to national, regional, and local organizations of oncology and palliative care, as well as to the culture of the organization.
Background: Comfort evaluation is one of the major challenges in the palliative care setting, particularly when it comes to non-communicative patients. For this specific population, validated tools for comfort evaluation are scarce and healthcare professionals have to rely on their clinical sense and experience. Objectives: To provide arguments for the use of Analgesia/Nociception Index (ANI) monitoring in order to improve clinical comfort evaluation. Methods: We conducted a retrospective cohort study of non-communicative patients at the end of their lives whose comfort was evaluated clinically and with ANI. We focused on the coherence or discordance of clinical and ANI evaluations and on pharmacological interventions driven by them. Results: 58 evaluations from 33 patients were analyzed. Clinical and demographic characteristics were highly variable. Simultaneous clinical and ANI evaluations were concordant in 45 measurements (77.58%), leading mostly to no treatment modification when indicating comfort and to increasing anxiolytic or pain-relief treatments when indicating discomfort. Thirteen (22.41%) evaluations were discordant, leading mostly to treatment incrementation. Conclusion: We suggest that the ANI monitor is a reliable tool in the palliative setting and may help provide patients with the best symptom relief and the most appropriate therapeutics.
ObjectivesAlpha-2 agonists have analgesic and sedative properties that can prove interesting in palliative care. The main objective of this study was to describe the use of clonidine and dexmedetomidine in palliative care units (PCU). The secondary objective was to identify physicians’ perspectives and attitudes toward alpha-2-agonists.MethodsInternational multicentric qualitative survey of prescribing characteristics and attitudes towards alpha-2 agonist. All 159 PCUs in France, Belgium and French-speaking Switzerland were contacted, and 142 physicians answered the questionnaire (31% participation).Results20% of the practitioners surveyed prescribe these molecules are mainly for analgesic and sedative indications. There was considerable heterogeneity in the modalities and dosages of administration. The use of clonidine is more frequent and common in Belgium, while dexmedetomidine is only used in France. There is a high level of satisfaction among practitioners who use these molecules, with the desire of the majority of respondents to obtain additional studies and information on alpha-2-agonists.ConclusionAlpha-2 agonists are little known and little prescribed by French-speaking palliative care physicians but are of interest because of their potential in this field. Phase 3 studies could justify the use of these molecules in palliative situations and would contribute to harmonising professional practices.
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