Abstract Topic: 35. Quality of life and palliative care
Background: Patients with blood cancers experience high-intensity medical care near the end of life (EOL), have low rates of hospice and palliative care (PC), and are more likely to die in a hospital. Offering PC to hematological patients regardless of diagnosis and prognosis is a concept emphasized by recent reports from the European Hematology Association and the World Health Association. The goals of care (GOC) in the treatment of terminal cancer patients include low chemotherapy use, low access to the emergency room (ER) or intensive care unit (ICU), and a low rate of hospital deaths. However, scanty information about the rate of this GOC in hematological patients is available.
Aims: This retrospective observational study aimed to evaluate the achievement of these quality indicators in patients followed by the hematologist with or without the palliativist.
Methods: We evaluated a cohort of consecutive patients with hematologic diseases followed at our institution who died between January 2021 and December 2022. The quality indicators evaluated were: the use of antineoplastic therapy in EOL, place of death, transfusions, ER access, ICU access, and days of hospitalization in the last month of life.
Results: 144 patients were enrolled. 57 (39.6%) were offered PC (Group 1), and 87 (60.4%) were cared by the hematologist alone (Group 2). Mean age, gender, lines of therapy, and diagnoses were comparable in the two groups (figure 1A). Patients referred to PC were followed for an average of 94 days, range 1-1249 days.
We found a statistically significant difference for each GOC in favor of Group 1 compared to Group 2. Patients of Group 1 underwent less aggressive treatment in EOL; none of them was intubated or admitted to ICU in the last month of life. Furthermore, the rate of transfusion or chemotherapy in Group 1 was less than half that of Group 2, as was the number of hospitalization days. Finally, 91.2% of Group 1 patients died at home or in hospice, while 74.7% of Group 2 patients died in a hospital (four of them in the ER [figure 1B]).
Summary/Conclusion: Many patients who died from hematological malignancies received intensive treatment near the EOL. Our data show that this rate is significantly lower when a PC team follows patients. Improved and earlier integration of the PC approach should be a goal of the practice of hematology patients with malignancy.
Figure 1A. Clinical characteristics. Group 1: patients followed by hematologists and palliative care. Group 2: patients followed only by hematologists. PC, palliative care; AL, acute leukemia; DLBCL, diffuse large B cell lymphoma; MM, multiple myeloma; MDS, myelodysplastic syndrome.
Figure 1B. End-of-life goals of care stratified according to receiving palliative care (Group 1) or only hematologic care (Group 2). PC, palliative care; BD, before death; RBC, red blood cell; PLT, platelets; ER, emergency room; ICU, intensive care unit.
Keywords: Supportive care, Health care, Quality of life