Abstract Topic: 35. Quality of life and palliative care
Background: The emergence of new treatment strategies to establish a potential cure has generated an optimistic attitude in haematologists who see new therapeutic options for their patients. It is essential to know which patients are candidates for these measures and when referral to the palliative care unit (PCU) is necessary.
Training in the development of new drugs has not gone hand in hand with greater progress in palliative care. Haematologists have a lower tendency to refer to palliative care compared to other specialists such as oncologists. There is a need to broaden the knowledge of palliative care to ensure the best possible quality of the last days of life.
Aims: To describe the end-of-life situation in our centre in patients with a haematological diagnosis.
Methods: We analysed the population of patients who died in the haematology department of our centre from 2010-2016. We collected demographic variables, haematological assessment (diagnosis and previous lines), as well as hospital care prior to the time of death: admissions in the last year and previous treatment administered (15-30 and 30-90 days prior). Referral to the PCU was assessed. Early referral (ER) was defined as the referral done in the 3 years before the date of death and referral in end-of-life (REL) when it was done previous to date of death. All statistical tests were performed with the IBM SPSS Statistics v. 26.0. Quantitative variables are expressed through variables of central tendency, median, and interquartile range.
Results: A population of 99 patients was analysed, 40.4% (n=40) were women while 59.6% (n=59) were men. The median age at the time of death was 72(64-80) years. Among the patients, 32.3% (n=32) had previously been diagnosed with multiple myeloma, 19.2% (n=19) with acute myeloid leukaemia, 34.3% (n=34) with lymphoma, and 14.1% (n=14) with myelodysplastic syndrome.
The cause of death was progression of the underlying disease in 73.7% (n=73), infectious aetiology in 15.2% (n=15), mixed cause (progression and infection) in 10.1% (n=10) and other causes in 1% (n=1). Median overall survival was 31 (10-55) months. The median number of lines of treatment previously received was 3 (2-5), 48.5% (n=48) had received chemotherapy treatment in the 15-30 days prior to death and 48.5% (n=48) in the 30-90 days.
All patients in the cohort had been admitted in the year before death, with a median number of admissions of 3 (2-5) and a median length of stay of 50 days (27-77). In the last 3 months, the median number of days of admission was 28 (13-43). 77.8% (n=11) had no ER to the PCU, while 22.2% (n=22) were referred; 35.4% (n=35) had no REL while 64.6% (n=64) were referred.
Summary/Conclusion: The results of the study carried out at our centre show that haematological patients die in most cases due to progression of the underlying disease, with almost half of them receiving active treatment in the days prior to death. In addition, in the last year they had been admitted for prolonged periods of time. Referral to the PCU is not made in all cases and occurs in the days before death.
These data demonstrate the need to develop protocols for early referral to the PCU in haematology, as well as better training in recognition of the patient in the last days of life in to avoid futile admissions and treatment.
Keywords: Lymphoid malignancy