Abstract Topic: 35. Quality of life and palliative care
Background: Elderly patients diagnosed with hematological malignancies are particularly fragile, not only because of their prognosis (often unfortunate), but also because of the toxicity of the existing treatments and comorbidities, to which must be added the isolation of rural populations. All this amount has a negative impact on their quality of life.
As of January 2018, thanks to the conjunction of the Hematology and Palliative Care Services, the first rural Hematopalliative Unit in Spain was implemented. This multidisciplinary unit is made up of medical specialists in Hematology and Palliative Care, home nursing and Day Hospital and Psychology staff.
Aims: The objective is to analyze whether the dual assessment by the Hematology and Home Palliative Care Services (through our pioneer unit) has a positive impact on quality of life (assessed through the number of hospitalizations, the number of trips to the hospital and compliance with last wishes) in oncohematological patients who are not candidates for aggressive antineoplastic treatment in rural areas.
Methods: We evaluated in a descriptive, unicentric and retrospective way since the creation of the Rural Hematopalliative Unit (from 01-2018 to 01-2023), a total of 50 patients diagnosed with hematological neoplasms who were not candidates for “intensive” chemotherapy treatment (independent or not of receive antineoplastic treatment adjusted for comorbidities or only palliative measures) who met any of the following inclusion criteria (age ≥70 years, ECOG ≥1 point, residence outside the urban perimeter or socio-sanitary assessment of risk of social problems). Clinical, analytical and socio-sanitary data were collected.
Results: The median age was 85 years (range: 71-93 years) with a predominance of females (68%) and altered functional status (58% ECOG ≥2 points). The median distance between home and the hospital was 34.5 km (range: 1-67 km). In 74% of the patients, the children were the main caregivers within the family nucleus. Non-Hodgkin lymphoma (NHL) were the most frequent hematological malignancies in the sample (42%), followed by acute myeloblastic leukemia (AML: 28%) and multiple myeloma (MM: 24%). 42% of the sample (21 patients) have received chemotherapy treatment adjusted for comorbidities (48% of NHL, 29% of LAM and 17% of MM). The entire sample diagnosed with LAM required at some point transfusion support with packed red blood cells (median 9 packed, range: 1-45), 71.4% required support with platelet pools and 21.4% with fresh plasma. The entire sample positively assessed the reduced need for hospital travel, and even more so in times of the COVID-19 pandemic. Only 24% of the sample required hospital readmission for reasons other than death, with a median of 7 days of admission. 80% of the sample has died, of which the majority (53%) has been at home.
Summary/Conclusion: Comprehensive home care by multidisciplinary Hematology and Palliative Care units in patients with hematological malignancies who are not candidates for intensive chemotherapy treatment in rural areas is feasible and has potential positive effects in terms of reducing the need for hospitalizations, reducing the number of trips to the center of reference and enabling a dignified home death following the wills of the patients, for which we believe that it should be a bet for the present and the future of our specialty in other areas with great geographical dispersion.
Keywords: Supportive care, Hematological malignancy, Health care, Quality of life