Advertisement

Supportive Care in Cancer

, Volume 20, Issue 11, pp 2895–2902 | Cite as

Dying of hematologic patients—treatment characteristics in a German University Hospital

  • Patrick BrückEmail author
  • Malgorzata Pierzchlewska
  • Marta Kaluzna-Oleksy
  • Maria Elizabeth Ramos Lopez
  • Mathias Rummel
  • Dieter Hoelzer
  • Angelika Böhme
Original Article

Abstract

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.

Keywords

Hematology Palliative medicine Treatment characteristics 

Notes

Acknowledgments

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

Primary data is under full control of the authors, as all data were extracted from the clinical documentation of each patient.

References

  1. 1.
    DeVita VT, Chu E (2008) A history of cancer chemotherapy. Cancer Res 68(21):8643–8653PubMedCrossRefGoogle Scholar
  2. 2.
    McGrath P, Holewa H (2007) Special considerations for haematology patients in relation to end-of-life care: Australian findings. Eur J Cancer Care 16:164–171CrossRefGoogle Scholar
  3. 3.
    Nightingale E (2000) Quality in palliative care. Aust Health Cons 3(2):39–40Google Scholar
  4. 4.
    Cella DF (1995) Measuring quality of life in palliative care. Semin Oncol 22(2 Suppl 3):73–81PubMedGoogle Scholar
  5. 5.
    Strasser F, Blum D, Bueche D (2010) Invasive palliative interventions: when are they worth it and when are they not? Cancer J 16(5):483–487PubMedCrossRefGoogle Scholar
  6. 6.
    Bookbinder M, McHugh ME (2010) Symptom management in palliative care and end of life care. Nurs Clin North Am 45(3):271–327PubMedCrossRefGoogle Scholar
  7. 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
  8. 8.
    Niscola P, Tendas A, Scaramucci L, Giovaninni M, Cupelli L, De Sanctis V, Brunetti GA, Bondanini F, Palumbo R, Lamanda M, Battistini R, Cartoni C, Romani C, Arcuri E (2011) Pain in malignant hematology. Expert Rev Hematol 4(1):81–93PubMedCrossRefGoogle Scholar
  9. 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
  10. 10.
    Muller-Busch HC, Andres I, Jehser T (2003) Sedation in palliative care—a critical analysis of 7 years experience. BMC Palliat Care 2(1):2PubMedCrossRefGoogle Scholar
  11. 11.
    Sykes N, Thorns A (2003) Sedative use in the last week of life and the implications for end-of-life decision making. Arch Intern Med 163:341–344PubMedCrossRefGoogle Scholar
  12. 12.
    Bauduer F, Capdupuy C, Renoux M (2000) Characteristics of deaths in a department of oncohaematology within a general hospital: a study of 81 cases. Supp Care Cancer 8:302–306CrossRefGoogle Scholar
  13. 13.
    Earle CC, Landrum MB, Souza JM, Neville BA, Weeks JC, Ayanian JZ (2008) Aggressiveness of cancer care near the end of life: is it a quality-of-care issue? J Clin Oncol 26:3860–3866PubMedCrossRefGoogle Scholar
  14. 14.
    Emanuel EJ, Young-Xu Y, Levinsky NG, Gazelle G, Saynina O, Ash AS (2003) Chemotherapy use among Medicare beneficiaries at the end of life. Ann Intern Med 138:639–643PubMedGoogle Scholar
  15. 15.
    Earle CC, Neville BA, Landrum MB, Ayanian JZ, Block SD, Weeks JC (2004) Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol 22(2):315–321PubMedCrossRefGoogle Scholar
  16. 16.
    Martoni AA, Tanneberger S, Mutri V (2007) Cancer chemotherapy near the end of life: the time has come to set guidelines for its appropriate use. Tumori 93(5):417–422PubMedGoogle Scholar
  17. 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
  18. 18.
    Sullivan AM, Lakoma MD, Matsuyama RK, Rosenblatt L, Arnold RM, Block SD (2007) Diagnosing and discussing imminent death in the hospital: a secondary analysis of physician interviews. J Palliat Med 10(4):882–893PubMedCrossRefGoogle Scholar
  19. 19.
    Mackillop WJ, Stewart WE, Ginsburg AD, Stewart SS (1998) Cancer patients’ perceptions of their disease and its treatment. Br J Cancer 58(3):355–358CrossRefGoogle Scholar
  20. 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
  21. 21.
    Mack JW, Weeks JC, Wright AA, Block SD, Prigerson HG (2010) End-of-life discussions, goal attainment, and distress at the end of life: predictors and outcomes for receipt of care consistent with preferences. J Clin Oncol 28(7):1203–1208PubMedCrossRefGoogle Scholar
  22. 22.
    Hill QA (2010) Intensify, resuscitate or palliate: decision making in the critically ill patient with haematological malignancy. Blood Rev 24(1):17–25PubMedCrossRefGoogle Scholar
  23. 23.
    Nosari A, Barberis M, Landonio G, Magnani P, Majno M, Oreste P, Sozzi P (1991) Infections in haematologic neoplasms: autopsy findings. Haematologica 76:135–140PubMedGoogle Scholar
  24. 24.
    Oneschuk D, Fainsinger R, Demoissac D (2002) Antibiotic use in the last week of life in three different palliative care settings. J Palliat Care 18(1):25–28PubMedGoogle Scholar
  25. 25.
    Reinbolt RE, Shenk AM, White PH, Navari RM (2005) Symptomatic treatment of infections in patients with advanced cancer receiving hospice care. J Pain Symptom Manag 30:175–182CrossRefGoogle Scholar
  26. 26.
    White PH, Kuhlenschmidt HL, Vancura BG, Navari RM (2003) Antimicrobial use in patients with advanced cancer receiving hospice care. J Pain Symptom Manag 25(5):438–443CrossRefGoogle Scholar
  27. 27.
    Dunn A, Carter J, Carter H (2003) Anemia at the end of life: prevalence, significance, and causes in patients receiving palliative care. J Pain Symptom Manag 26:1132–1139CrossRefGoogle Scholar
  28. 28.
    Stalfelt AM, Brodin H, Pettersson S, Eklöf A (2003) The final phase in acute myeloid leukaemia (AML): a study on bleeding, infection and pain. Leuk Res 27:481–488PubMedCrossRefGoogle Scholar
  29. 29.
    Wandt H, Ehninger G, Gallmeier WM (2001) New strategies for prophylactic platelet transfusion in patients with hematologic diseases. Oncologist 6:446–450PubMedCrossRefGoogle Scholar
  30. 30.
    Bruera E, Belzile M, Watanabe S, Fainsinger RL (1996) Volume of hydration in terminal cancer patients. Supp Care Cancer 4:147–150CrossRefGoogle Scholar
  31. 31.
    Oh DY, Kim JH, Lee SH, Kim DW, Im SA, Kim TZ, Heo DS, Bang YJ, Kim NK (2007) Artificial nutrition and hydration in terminal cancer patients: the real and the ideal. Supp Care Cancer 15:631–636CrossRefGoogle Scholar
  32. 32.
    Higginson IJ, Sen-Gupta GJ (2000) Place of care in advanced cancer: a qualitative systematic literature review of patient preferences. J Palliat Med 3(3):287–300PubMedCrossRefGoogle Scholar
  33. 33.
    Niscola P, de Fabritiis P, Cartoni C, Romani C, Sorrentino F, Dentamaro T, Piccioni D, Scaramucci L, Giovannini M, Amadori S, Mandelli F (2006) Home care management of patients affected by hematologic malignancies: a review. Haematologica 91(11):1523–1529PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Patrick Brück
    • 1
    • 2
    • 5
    Email author
  • Malgorzata Pierzchlewska
    • 2
  • Marta Kaluzna-Oleksy
    • 2
  • Maria Elizabeth Ramos Lopez
    • 3
  • Mathias Rummel
    • 1
  • Dieter Hoelzer
    • 2
    • 4
  • Angelika Böhme
    • 2
    • 4
  1. 1.Department of Medicine, Haematology and OncologyUniversity Hospital of GiessenGiessenGermany
  2. 2.Department of Medicine, Hematology and OncologyUniversity Hospital of Frankfurt a. M.Frankfurt am MainGermany
  3. 3.Department of Medicine, Endocrinology and DiabetesUniversity Hospital of Frankfurt a. M.Frankfurt am MainGermany
  4. 4.Onkologikum, Frankfurt am MuseumsuferFrankfurt am MainGermany
  5. 5.Department of Hematology and Oncology, Centre of Internal MedicineUniversity Hospital GiessenGiessenGermany

Personalised recommendations