Dying of hematologic patients—treatment characteristics in a German University Hospital
- 362 Downloads
The treatment of hematologic patients in palliative situations remains a major challenge as there are special clinical needs, e.g., transfusions and the high risk for infectious complications with subsequent use of broad anti-infective treatment. Furthermore, most hematologic patients have a relatively long history of disease and are acquainted with “their” wards; that is why most are treated on these hematologic and not on specialized palliative wards. The standardized approach to the care of hematologic patients with curative treatment intention is probably not fully appropriate for palliative patients. In order to evaluate the current situation of treatment characteristics in a German university hospital, we retrospectively evaluated the medical documentation of all patients who died on a hematologic ward between 2005 and 2008. While we found a high number of chemotherapeutic, anti-infective, analgesic, and sedative treatments, of transfusions, of treatment on the intensive care units, and of invasive nature, non-somatic interventions were rather scarce. Symptom control, e.g., for bleeding events or pain, was frequently not adequately achieved. With regard to the palliative situation, a holistic approach with the maintenance of patients’ autonomy and the preference for dying at home, the treatment of hematologic patients in a palliative situation has to be reconsidered.
KeywordsHematology Palliative medicine Treatment characteristics
We deeply acknowledge our patients and their relatives for their continued trust in us.
Conflict of interest
All authors state that there are no conflicts of interest.
Primary data is under full control of the authors, as all data were extracted from the clinical documentation of each patient.
- 3.Nightingale E (2000) Quality in palliative care. Aust Health Cons 3(2):39–40Google Scholar
- 7.Krug U, Röllig C, Koschmieder A, Heinecke A, Sauerland MC, Schaich M, Thiede C, Kramer M, Braess J, Spiekermann K, Haferlach T, Haferlach C, Koschmieder S, Rohde C, Serve H, Wörmann B, Hiddemann W, Ehninger G, Berdel WE, Büchner T, Müller-Tidow C, for the German Acute Myeloid Leukaemia Cooperative Group and the Study Alliance Leukemia Investigators (2010) Complete remission and early death after intensive chemotherapy in patients aged 60 years or older with acute myeloid leukaemia: a web-based application for prediction of outcomes. Lancet 376:2000–2008Google Scholar
- 9.Hanks GW, de Conno F, Cherny N, Hanna M, Kalso E, McQuay HJ, Mercadante S, Meynadier J, Poulain P, Ripamonti C, Radbruch L, Roca I, Casas J, Sawe J, Twycross RG, Ventafridda V (2001) Morphine and alternative opioids in cancer pain: the EAPC recommendations. Expert Working Group of the Research Network of the European Association for Palliative Care. Br J Cancer 84(5):587–593PubMedCrossRefGoogle Scholar
- 17.Koedoot CG, Oort FJ, de Haan RJ, Bakker PJ, de Graeff A, de Haes JC (2004) The content and amount of information given by medical oncologists when telling patients with advanced cancer what their treatment options are: palliative chemotherapy and watchful-waiting. Eur J Cancer 40(2):225–235PubMedCrossRefGoogle Scholar
- 20.Chow E, Andersson L, Wong R, Vachon M, Hruby G, Franssen E, Fung KW, Harth T, Pach B, Pope J, Connolly R, Schueller T, Stefaniuk K, Szumacher E, Hayter C, Finkelstein J, Danjoux C (2001) Patients with advanced cancer: a survey of the understanding of their illness and expectations from palliative radiotherapy for symptomatic metastases. Clin Oncol (R Coll Radiol) 13(3):204–208Google Scholar