Abstract
The use of palliative care (PC) in the support of patients with hematologic malignancies (HM) has been complicated, both in the inpatient and outpatient settings. To be honest, patients with hematologic malignancies are rarely referred to palliative care in the outpatient setting. We suspect this is for many reasons which we will explore below. Typically, if palliative care becomes involved with this population, it is most often during a hospital admission. Historically, clinicians caring for patients with HM have made fewer referrals to palliative care than any other cancer type. There is little data focused on palliative care in this population. In our clinical experience, we feel that there is patient need within this population, both in symptom management, specifically pain management, and assistance with coping. Cultural barriers within the field of HM are likely a contributing factor to reduced referrals and is examined in this chapter.
Goals-of-care conversations and barriers to hospice referral, including blood transfusion and other supportive measures seen in HM, will also be discussed.
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References
Calton BA, Alvarez-Perez A, Portman DG, Ramchandran KJ, Sugalski J, Rabow MW. The current state of palliative care for patients care for at leading US Cancer Centers: the 2015 NCCN Palliative Care Survey. J Palliat Care. 2016;14:7.
Hui D, Kim S-H, Kwon JH, Tanco KC, Zhang T, et al. Access to palliative care among patients treated at a comprehensive cancer center. Oncologist. 2012;17:1574–80.
Porta-Sales J, Guerrero-Torrelles M, Moreno-Alonso D, Sarrà-Escarré J, Clapés-Puig V, et al. Is early palliative care feasible in patients with multiple myeloma? J Pain Symptom Manag. 2017;54(5):692–700.
World Health Organization. WHO definition of palliative care. 2015. http://www.who.int/cancer/palliative/definition/en/. Accessed 27 Jan 2016.
Desai AV, Klimek VM, Chow K, Epstein AS, Bernal C, Anderson K, Okpako M, Rawlins-Duell R, Kramer D, Romano D, Goldberg JI, Nelson JE. 1-2-3 Project: A quality improvement initiative to normalize and systematize palliative care for all patients with cancer in the outpatient clinic setting. J Oncol Pract. 2018;14(12):e775–85.
Ruiz M, Reynolds P, Marranzini R, Khan A, Ketterer J, Brahim A. Role of early palliative care interventions in hematological malignancies and bone marrow transplant patients: barriers and potential solutions. Am J Hosp Palliat Care. 2018;35(11):1456–60.
Zhuang H, Ma Y, Wang L, Zhang H. Effect of early palliative care on quality of life in patients with non-small-cell lung cancer. Curr Oncol. 2018;25(1):e54–8. https://doi.org/10.3747/co.25.3639.
Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363:733–42.
Mah K, Chow B, Swami N, Pope A, Rydall A, Earle C, Krzyzanowska M, Le L, Hales S, Rodin G, Hannon B, Zimmermann C. Early palliative care and quality of dying and death in patients with advanced cancer. BMJ Support Palliat Care. 2021;2021:002893. https://doi.org/10.1136/bmjspcare-2021-002893.
Porta-Sales J, Guerrero-Torrelles M, Moreno-Alonso D, et al. Is early palliative care feasible in patients with multiple myeloma? J Pain Symptom Manag. 2017;54(5):692–700.
LeBlanc TW, El-Jawahri A. When and why should patients with hematologic malignancies see a palliative care specialist? Hematology. 2015;2015:471–8.
Watanabe SM, et al. A multicenter study comparing two numerical versions of the Edmonton Symptom Assessment System in palliative care patients. J Pain Symptom Manag. 2011;41(2):456–68.
Nekolaichuk CL, Fainsinger RL, Lawlor PG. A validation study of a pain classification system for advanced cancer patients using content experts: the Edmonton Classification System for Cancer Pain. Palliat Med. 2005;19(6):466–76.
Anderson F, Downing GM, Hill J, Casorso L, Lerch N. Palliative Performance Scale (PPS): a new tool. J Palliat Care. 1996;12(1):5–11.
LeBlanc TW, Roeland EJ, El-Jawahri A. Early palliative care for patients with hematologic malignancies: is it really so difficult to achieve? Curr Hematol Malig Rep. 2017;12(4):300–8. https://doi.org/10.1007/s11899-017-0392-z.
El-Jawahri A, Nelson-Lowe M, VanDusen H, Traeger L, Abel GA, Greer JA, Fathi A, Steensma DP, LeBlanc TW, Li Z, DeAngelo D, Wadleigh M, Hobbs G, Foster J, Brunner A, Amrein P, Stone RM, Temel JS. Patient-clinician discordance in perceptions of treatment risks and benefits in older patients with acute myeloid leukemia. Oncologist. 2019;24(2):247–54. https://doi.org/10.1634/theoncologist.2018-0317.
El-Jawahri A, Nelson AM, Gray TF, Lee SJ, Leblanc TW. Palliative and end-of-life care for patients with hematologic malignancies. J Clin Oncol. 2019;38(9):944.
Fadul NA, El Osta B, Dalal S, Poulter VA, Bruera E. Comparison of symptom burden among patients referred to palliative care with hematologic malignancies versus those with solid tumors. J Palliat Med. 2008;11:422–7.
Busolo D, Woodgate R. Palliative care experiences of adult cancer patients from ethnocultural groups: a qualitative systematic review protocol. JBI Database Syst Rev Implement Rep. 2015;12(1):99–111.
Connors AF, Dawson NV, Desbiens NA, et al. A controlled trial to improve care for seriously III hospitalized patients: the study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). JAMA. 1995;274(20):1591–8. https://doi.org/10.1001/jama.1995.03530200027032.
Adams JA, Bailey DE Jr, Anderson RA, Docherty SL. Nursing roles and strategies in end-of-life decision making in acute care: a systematic review of the literature. Nurs Res Pract. 2011;2011:527834. https://doi.org/10.1155/2011/527834.
Cheng HB, Li C, Chan K, et al. End-of-life characteristics and palliative care provision for elderly patients suffering from acute myeloid leukemia. Support Care Cancer. 2015;23:111–6. https://doi.org/10.1007/s00520-014-2333-x.
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Carlson, H.A., Sousa, A. (2023). Hematologic Malignancy and Palliative Care Integration in the Outpatient Setting. In: Ullrich, C.K., Roeland, E.J. (eds) Palliative Care in Hematologic Malignancies and Serious Blood Disorders. Springer, Cham. https://doi.org/10.1007/978-3-031-38058-7_8
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