Palliative Care in Patients with Leukemia: When and How?
Purpose of Review
Patients with hematologic malignancies get more aggressive treatment and the end-of-life, more ICU deaths, and prolonged hospital stays. In comparison to solid tumors, their access to palliative care and hospice is less.
Multiple factors seem to play a role including curative goals, different treatment options, stronger relationship between patients and oncologist, symptom burden, and limitations of hospice care.
Improving the perception of palliative care in these patients, characterizing their needs, and more education can help to increase referrals and access to palliative care. Innovative ways to improve integration between hematology-oncology and palliative care are needed.
KeywordsPalliative care Leukemia Hematologic malignancy Supportive care Hematology EOL
Compliance with Ethical Standards
Conflict of Interest
Marieberta Vidal, David Hui, and Eduardo Bruera declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 3.Howell DA, Wang HI, Roman E, Smith AG, Patmore R, Johnson MJ, et al. Variations in specialist palliative care referrals: findings from a population-based patient cohort of acute myeloid leukaemia, diffuse large B-cell lymphoma and myeloma. BMJ Support Palliat Care. 2015;5(5):496–502.CrossRefGoogle Scholar
- 14.• El-Jawahri AR, Abel GA, Steensma DP, TW LB, Fathi AT, Graubert TA, et al. Health care utilization and end-of-life care for older patients with acute myeloid leukemia. Cancer. 2015;121(16):2840–8 This is a retrospective analysis of 330 older patinets (> 60 yrs old) with AML that shows a minor use of palliative care services (16%) despite a high 2 year mostality of 85%. CrossRefGoogle Scholar
- 16.•• Odejide OO, Cronin AM, Condron NB, Fletcher SA, Earle CC, Tulsky JA, et al. Barriers to quality end-of-life care for patients with blood cancers. J Clin Oncol. 2016;34(26):3126–32 This is a larger national cohort study that include 349 hematologic oncologists were the top barrier for quality EOL care was unrealistic patinet expectations. CrossRefGoogle Scholar
- 18.•• Hui D, Bansal S, Park M, Reddy A, Cortes J, Fossella F, et al. Differences in attitudes and beliefs toward end-of-life care between hematologic and solid tumor oncology specialists. Ann Oncol. 2015;26(7):1440–6 This is a study of 240 clinicians were compared to solid tumor specialist , hematologic specialists were more likely to prescribe moderate toxic systemic therapy without survival benefit what reflect the differences in attitudes and beliefs toward the end of life. CrossRefGoogle Scholar
- 19.• Hui D, Cerana MA, Park M, Hess K, Bruera E. Impact of oncologists’ attitudes toward end-of-life care on patients’ access to palliative care. Oncologist. 2016;21(9):1149–55 In this study 182 oncologists from a tertiary care cancer center were survey and hematologic oncology specialists expressed lower comfort levels compared with their solid tumor counterparts in EOL care.CrossRefGoogle Scholar
- 22.• Hui D, Park M, Liu D, Reddy A, Dalal S, Bruera E. Attitudes and beliefs toward supportive and palliative care referral among hematologic and solid tumor oncology specialists. Oncologist. 2015;20(11):1326–32 This study show that hematologic specialist were less likely to refer new patients to palliative care than solid tumor specialist but this was much improve after service name was change to “supportive care” what seems to minimize the stigma and improve patient access. CrossRefGoogle Scholar