Palliative Care in Patients with Hematological Malignancies

Abstract

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.

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

“…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 ]. Our data support the ongoing need for inpatient specialist palliative care services in both acute and elective oncology settings with such a high proportion of cancer patients spending significant amounts of time in hospital in the last year and months of life.…”

Palliative Care for Patients With Hematologic Malignancies in a Low-Middle Income Country: Prevalence of Symptoms and the Need for Improving Quality of Attention at the End of Life

“…This suggests that the symptom burden is equal or greater in these patients than in those with solid malignancies. 22 -25 This, together with the adverse effects of chemotherapy, makes it more difficult to manage symptoms and predisposes patients to more visits to the emergency department and more hospitalizations, 26 which underscores that the care needs for patients with hematologic malignancies can differ substantially from those of patients with solid malignancies.…”

Use of symptom-focused oncological cancer therapies in hospices: a retrospective analysis

“…The integration of H1 into a network focusing on haematology and oncology is definitely an important factor. The conditions in H2 are more likely to reflect the reality in general care, especially because patients with a malignant haematological disease are under-represented in palliative care [34,35] and the integration of a hospice into a haematological/oncological network is no standard in Germany.…”