Early integrated palliative care for haematology cancer patients-the impact on symptom burden in Hong Kong

Abstract

Background: Evidence showed that early palliative care could have many benefits in clinical outcomes for patients living with advanced medical illnesses. In fact, most of these studies have not involved patients with advanced haematologic cancer (HC), which are known to be associated with significant physical and psychological symptoms. In Hong Kong, an Early Integrated Palliative Care (EIPC) collaboration involving both Heamatology unit of Queen Mary Hospital (QMH) and the Palliative Medical Unit of Grantham Hospital (GH) has been started since early 2018 as a better way to improve the service gap. The HC patients failed 2 or more lines of cancer treatment are identified during the joint round and hematology clinic. Some of these patients will be referred to our PC services. Our joint PC clinic has multidisciplinary input from palliative care physicians, hematologists, and clinical psychologists. The clinic program is well coordinated and structured. The HC patients are initially seen by the parent team for disease treatment and then by GH PC team for symptom control and psychosocial care.Methods: This was a retrospective study with a review of the clinical charts and electronic healthcare records of all patients who attended the Hematology PC clinic from June 2018 to September 2020. For the inclusion criteria, patients were found eligible if they had prospectively completed Edmonton Symptom Assessment Scale (ESAS) assessments for at least the initial and follow-up visits within a range of ≥7 days and ≤60 days of the first visit. Results: Thirty-eight patients ultimately agreed to the referral. The mean age was 70.5 (12.5) years old.Twenty-five patients (66%) had myelodysplastic syndrome (MDS); 10 (26%) had acute myeloid leukemia (AML). Around 50-60% of patients reported significant symptoms of fatigue, anxiety, drowsiness, and anorexia; 42% of patients had significantly depressed moods while 37% had pain. There were significant symptom improvements for pain, depression, and anxiety after follow-up visits. Conclusions:The study showed that our EIPC program resulted in a significant reduction in some of the important symptom item scores, including pain, anorexia, anxiety, and depression, after the follow-up visits.

Intensity of care in cancer patients in the last year of life: a retrospective data linkage study

“…It is increasingly understood that people with haematological cancers may have unmet palliative care needs and that there can be uncertainty about the optimal timing of palliative care in the patient journey [ 40 ]. It has been suggested that an understanding of the unique trajectories of people with haematological cancers is needed by specialist palliative care teams [ 41 ] and also that early, integrated palliative care alongside haematology treatments can be beneficial, with improved physical and psychological symptom control amongst other benefits [ 42 ]. A collaborative approach, both within multidisciplinary haematology teams, but also between haematology and specialist palliative care teams, has been proposed [ 43 ].…”

Longitudinal symptoms and temporal trends in palliative care, palliative radiotherapy, and anti-cancer treatment near end of life among patients with metastatic cancer

“…Several randomized controlled trials have demonstrated the benefits of concurrent specialty palliative care (PC) with oncologic care, with enhanced patient outcomes such as better quality of life and mood (1)(2)(3)(4)(5). Early supportive care is also associated with improved clinical symptoms and less intensive end-of-life interventions (6,7).…”

Perspective of palliative care in radiation-oncology

“…According to World Health Organization (WHO), palliative care (PC) could improve the symptom and psychosocial aspects of patients with advanced medical illness (1). Early PC had been shown to improve symptom burden, quality of life and other clinical outcomes in advanced cancer patients (2)(3)(4).…”

“…The authors speculated that misconceptions on the purpose of PC and the timing for referral, thus might have led to a delay to specialty PC for patients who received multiple prior palliative chemotherapy regimens at EOL. It is recommended that two or more lines of palliative chemotherapy could be a trigger for early specialty PC referral as to facilitate advance care planning discussions which could reduce use of some of unnecessary EOL treatments e.g., chemotherapy (2). Much work still has been done to improve the timing for early PC.…”

“…Another limitation is lack of blood cancer patients in this study. Patients with hematologic malignancies (HM) were not included as they are not commonly treated with palliative RT (2). Those with HM who receive palliative RT are usually patients with a different disease trajectory from that of advanced solid cancer, e.g., follicular or cutaneous T cell lymphomas.…”