Early integration of palliative care for patients with haematological malignancies

Shaulov, Adir; Aviv, Ariel; Alcalde-Castro, Jacqueline; Zimmermann, Camilla

doi:10.1111/bjh.18286

Cited by 23 publications

(25 citation statements)

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“…The review includes issues critical to HM such as transfusions of blood products, infection management and use of growth factors as well as more general issues such as symptom management all of which may serve hemato-oncology teams seeking to improve PC skills. However, in comparison with solid tumors, studies of PC in the hematology literature are far less common, leading to gaps in knowledge (1,12). For example, there is a lack of strong evidence for use of blood products and growth factors for alleviation of symptoms in advanced HM rather than to support aggressive treatment, as reviewed by Chan et al (11).…”

Section: Researchmentioning

confidence: 99%

“…Future studies should also take into consideration the variety of HM as well as the varying trajectories of these diseases. Patients with aggressive diseases characterized by sudden and extreme changes in clinical status in an otherwise curable disease may have different needs entailing different models of care than those with indolent, prolonged, albeit incurable disease (12).…”

Section: Researchmentioning

confidence: 99%

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Palliative care for patients with hematological malignancies—beyond specialist care

Shaulov¹,

Aviv²

2023

Ann Palliat Med

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Section: Researchmentioning

confidence: 99%

Section: Researchmentioning

confidence: 99%

Palliative care for patients with hematological malignancies—beyond specialist care

Shaulov¹,

Aviv²

2023

Ann Palliat Med

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“…Multiple barriers to quality end of life (EOL) care in patients with HM have been described, including transfusion dependence, 8 a lack of reliable EOL indicators 9 as well as resistance toward PC and a reluctance to discuss death and dying among hematological oncologists 10–12 . Although the benefits of early PC have been well established in solid tumor patients, 13,14 data from randomized controlled trials indicating the benefit of early PC in HM patients has only recently begun to emerge 15–18 …”

Section: Introductionmentioning

confidence: 99%

Comparing end‐of‐life care of hematologic malignancy versus solid tumor patients in a tertiary care center

Burstein

Aviv

Even‐Zohar

et al. 2023

European J of Haematology

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ObjectivesTo compare end‐of‐life (EOL) care for solid tumor and hematologic malignancy (HM) patients.MethodsWe collected data on the last 100 consecutive deceased HM and 100 consecutive deceased solid tumor patients who died prior to June 1st 2020, treated at a single center. We compared demographic parameters, cause of death as ascertained by review of medical records by two independent investigators, and EOL quality indicators including: place of death, use of chemotherapy or targeted/biologic treatment, emergency department visits as well as hospital, inpatient hospice and Intensive Care Unit admissions and the time spent as inpatient over the last 30 days of life; mechanical ventilation and use of blood products during the last 14 days of life.ResultsIn comparison with solid tumor patients, HM patients more commonly died from treatment complications (13% vs. 1%) and unrelated causes (16% vs. 2%, p < .001 for all comparisons). HM patients died more frequently than solid tumor patients in the intensive care unit (14% vs. 7%) and the emergency department (9% vs. 0%) and less frequently in hospice (9% vs. 15%, p = .005 for all comparisons). In the 2 weeks prior to death HM patients were more likely than solid tumor patients to undergo mechanical ventilation (14% vs. 4%, p = .013), receive blood (47% vs. 27%, p = .003) and platelet transfusions (32% vs. 7%, p < .001); however, no statistical difference was found in use of either of chemotherapy (18% vs. 13%, p = .28) or targeted treatment (10% vs. 5%, p = .16).ConclusionsHM patients were more likely than solid tumor patients to undergo aggressive measures at EOL. Rarity of HM deaths, frequently caused by complications of treatment and unrelated causes, may affect treatment choices at EOL.

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“…Indeed, Chan et al (10) present their article as a resource/guide for both PC and hematooncology clinicians. Further, education on PC for patients and family caregivers may also help to erode some of the misperceptions and stigma associated with PC (25). Finally, as Chan et al (10) describe, hemato-oncology clinicians should possess basic PC competencies and skills to be able to provide primary PC and adopt a palliative approach to care.…”

mentioning

confidence: 99%

“…As Wedding (4) pointed out, approximately 9.5% of all cancer deaths are caused by HMs in the United States and yet only 0.4% of published studies on PC are in patients with HMs. Research is needed to both determine the unique needs of patients with HMs and to assess the effectiveness and role of PC for patients with HMs (4,25).…”

mentioning

confidence: 99%

Improving quantity and quality of life: supportive and palliative care for patients with advanced hematologic malignancies

Booker¹

2023

Ann Palliat Med

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Immense progress has been made in the understanding of, and treatment for, hematologic malignancies (HMs). Since the Food and Drug Administration approval of imatinib for the treatment of chronic myelogenous leukemia in early 2001 (1), the field has seen tremendous growth. More recent advances include engineered T-cell treatments, such as chimeric antigen receptor T-cells, and immunotherapies such as checkpoint inhibitors targeting programmed cell death ligand 1 (PD-L1) (2,3). While such developments have been found to lead to durable responses and improved survival, the integration of palliative and supportive care (SC) for patients with HMs has not kept pace. Symptom burden and treatment-related toxicities are known to be high in patients with HMs (4-8). Morbidity and mortality associated with HMs and their treatment continue to be high ( 9).In their article on SC and symptom management in patients with advanced HMs, Chan et al. (10) provide a comprehensive review of the SC needs of patients with HMs for palliative care (PC) and hematology-oncology providers. As has been well-described in the literature elsewhere, patients with HMs face significant physical and psychosocial symptom burden, which are at least comparable to patients with solid tumors (5-7). Such symptoms include, but are not limited to, pain, nausea and vomiting, anorexia, fatigue, drowsiness, dyspnea, delirium, depression, and anxiety (5-7). Tsatsou et al. (11) conducted a systematic review to examine the unmet SC needs of patients with HMs. The authors found that patients with HMs experienced an array of unmet needs including physical, emotional, practical, informational, and relational needs.Chan et al. (10) offer suggestions for management of disease and treatment-related symptoms, including: transfusion of blood products, prevention and management of infectious complications, and in-depth pain and symptom management. Elements of PC support, such as end-oflife (EOL) care and adopting a palliative approach to care, are mentioned and importantly, the authors conclude that further studies regarding the PC management for patients with advanced HMs are needed. It has been well documented that the terms "supportive care" and "palliative care" are often used interchangeably in the literature as well as clinically (12,13) and yet there are important distinctions that differentiate each term. The roots of PC can be traced back to the work of Canadian surgical oncologist Dr. Balfour Mount who has been credited with coining the term "palliative care" in the 1970s (14). In the ensuing years, the definition of PC has evolved and as per the World Health Organization, PC is now considered 'applicable early in the

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Early integration of palliative care for patients with haematological malignancies

Cited by 23 publications

References 100 publications

Palliative care for patients with hematological malignancies—beyond specialist care

Palliative care for patients with hematological malignancies—beyond specialist care

Comparing end‐of‐life care of hematologic malignancy versus solid tumor patients in a tertiary care center

Improving quantity and quality of life: supportive and palliative care for patients with advanced hematologic malignancies

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