Characteristics of Patients With Hematologic Malignancies Who Received Palliative Care Consultation Services in a Medical Center

Hung, Yu‐Shin; Wu, Jin‐Hou; Chang, Hong-Yeh; Wang, Po‐Nan; Kao, Chen-Yi; Wang, Hung‐Ming; Liau, Chi‐Ting; Chen, Jen‐Shi; Lin, Yung‐Chang; Su, Po‐Jung; Hsieh, Ching-Hua; Chou, Wen‐Chi

doi:10.1177/1049909112471423

Cited by 26 publications

(29 citation statements)

References 21 publications

(31 reference statements)

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“…Unlike previous studies comparing the palliative care symptoms of patients with solid and hematologic malignancies(31-34, 39), our study uses a real-world registry in a variety of settings of care and among diverse academic and community sites throughout the continental United States. Our results emphasize the need for improved access to specialty palliative care services among hematologic cancer patients with complex healthcare needs, as they likely have as much to benefit from these services as solid tumor patients do.…”

Section: Discussionmentioning

confidence: 99%

Comparing the Palliative Care Needs of Patients With Hematologic and Solid Malignancies

Hochman

Wolf

et al. 2018

Journal of Pain and Symptom Management

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Context Hematologic cancer patients use palliative care services less frequently than their solid tumor counterparts. Prior work suggests these patients have a sizeable symptom burden, but comparisons between hematologic and solid tumor patients near the end of life are limited. Objectives To compare unmet symptom needs in a cohort of hematologic and solid tumor patients referred to specialty palliative care services. Methods Using a novel data registry of initial palliative care encounters, we performed a cross-sectional analysis of cancer patients receiving care across seventeen sites within the Global Palliative Care Quality Alliance. We compared clinically-significant symptoms (rated as 4 or greater in severity) between hematologic and solid tumor patients and performed multivariate logistic regression analyses examining the relationship between symptom burden and tumor type. Results We identified 1,235 cancer patients, 108 of which had hematologic malignancies. Pain, dyspnea, nausea, and anorexia burden was as high among patients with hematologic as those with solid malignancies. Blood cancer patients had higher rates of clinically-significant tiredness (51% vs. 42%; p=0.03) than solid tumor patients. Finally, blood cancer patients had greater odds of being tired (odds ratio, 2.19; CI 1.22-3.91) and drowsy (odds ratio, 1.81; CI 1.07-3.07) than solid tumor patients independent of age, gender, race, and performance status. Conclusions Hematologic and solid tumor patients both have significant symptom burden at time of referral to palliative care services. Blood cancer patients may have unique concerns warranting targeted attention, including substantial drowsiness and tiredness. Our findings suggest a need to optimize palliative care usage in the hematologic cancer population.

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Section: Discussionmentioning

confidence: 99%

Comparing the Palliative Care Needs of Patients With Hematologic and Solid Malignancies

Hochman

Wolf

et al. 2018

Journal of Pain and Symptom Management

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“…For example, blood product transfusions and intravenous antibiotics are needed to manage complications, including bone marrow failure, anaemia, bleeding and sepsis, and pain may also be a significant problem. [34][35][36] The situation is complicated by factors such as the availability of multiple lines of treatment, even in the later disease stages, which may be given to manage symptoms rather than with curative or disease modifying intent. 28 29 In this context, chemotherapy may continue into the terminal phase, again complicating the transitions in care.…”

Section: Discussionmentioning

confidence: 99%

Preferred and actual place of death in haematological malignancy

Howell

Wang

Roman

et al. 2015

BMJ Support Palliat Care

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ObjectivesHome is considered the preferred place of death for many, but patients with haematological malignancies (leukaemias, lymphomas and myeloma) die in hospital more often than those with other cancers and the reasons for this are not wholly understood. We examined preferred and actual place of death among people with these diseases.MethodsThe study is embedded within an established population-based cohort of patients with haematological malignancies. All patients diagnosed at two of the largest hospitals in the study area between May 2005 and April 2008 with acute myeloid leukaemia, diffuse large B-cell lymphoma or myeloma, who died before May 2010 were included. Data were obtained from medical records and routine linkage to national death records.Results323 deceased patients were included. A total of 142 (44%) had discussed their preferred place of death; 45.8% wanted to die at home, 28.2% in hospital, 16.9% in a hospice, 5.6% in a nursing home and 3.5% were undecided; 63.4% of these died in their preferred place. Compared to patients with evidence of a discussion, those without were twice as likely to have died within a month of diagnosis (14.8% vs 29.8%). Overall, 240 patients died in hospital; those without a discussion were significantly more likely to die in hospital than those who had (p≤0.0001). Of those dying in hospital, 90% and 75.8% received haematology clinical input in the 30 and 7 days before death, respectively, and 40.8% died in haematology areas.ConclusionsMany patients discussed their preferred place of death, but a substantial proportion did not and hospital deaths were common in this latter group. There is scope to improve practice, particularly among those dying soon after diagnosis. We found evidence that some people opted to die in hospital; the extent to which this compares with other cancers is of interest.

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“…Patients with HM are more likely to die within 24 hours after hospice enrollment or within 7 days after hospice admission compared to solid tumor patients [4]. Further, they have longer median times from hospital admission to first palliative care consultation, but shorter median times from first palliative care consultation to death [5,6]. …”

Section: End-of-life Care In Patients With Hematological Malignanciesmentioning

confidence: 99%

“…Specific symptoms, especially drowsiness, delirium, tiredness, stomatitis, diarrhea, and symptoms, resulting from cytopenia including infection, fever, dyspnea, tiredness, and bleeding, are reported to be more frequent in patients with hematologic malignancies independent of age, gender, and performance status compared to solid tumor patients [5,6,7]. Pain, nausea, anorexia, and constipation had comparable prevalences in both groups [5,6,7]. Some studies also suggest that psychological, spiritual, and emotional concerns may not be properly and comprehensively addressed and quality of life may be decreased in patients with HM [8].…”

Section: Problems and Needs Of Patients With Advanced Hematological Mmentioning

confidence: 99%

Palliative Care in Patients with Hematological Malignancies

Oechsle¹

2018

Oncol Res Treat

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Patients with hematologic malignancies (HM) nowadays rarely receive palliative or hospice care, and studies on potential effects of integrated palliative care are rare. This narrative review provides a comprehensive overview on their current end-of-life care, first data on integrated specialist palliative care (SPC) and potential barriers. Symptom burden and distress in patients with HM seem to be comparable to other cancer patients, but their performance status and specific symptoms are even worse. Prolongation of life usually remains the main focus until the last days or weeks of life. Their chance to die in hospital is twice as high, but their chance to receive specialist palliative or hospice care is only half of that of other cancer patients. Prospective studies indicate a high acceptability and positive effects of integrated SPC, e.g. clarification of treatment goals, stabilization of quality of life, decreased depression, anxiety, symptom burden, and post-traumatic stress disorders. Interdisciplinary cooperation, timely discussions about SPC referral, and indicators to ‘flag' patients in need for SPC are important, but they are largely missing. In conclusion, further studies have to evaluate factors identifying patients with HM in need for SPC. Further models of early integrated palliative care should be evaluated in prospective studies and established in daily clinical practice.

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Characteristics of Patients With Hematologic Malignancies Who Received Palliative Care Consultation Services in a Medical Center

Cited by 26 publications

References 21 publications

Comparing the Palliative Care Needs of Patients With Hematologic and Solid Malignancies

Comparing the Palliative Care Needs of Patients With Hematologic and Solid Malignancies

Preferred and actual place of death in haematological malignancy

Palliative Care in Patients with Hematological Malignancies

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