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Palliative Care for Patients with Haematological Malignancies

  • Chapter
Palliative Care in Oncology

Abstract

Tremendous therapeutic advance has been made in treating patients with haematological disease during the past decades. Despite this, very many patients will eventually die from their disease, and another number of patients will die from complications and side effects of the therapeutic regimen itself. Given the burdensome and disease-specific course of most haematological malignancies, very little is known about the specific clinical, nursing and psychosocial needs of patients suffering from incurable and advanced haematological disease. Therefore, this chapter will on the one hand seek to provide haematologists with knowledge on the assessment and multi-professional care of this particularly vulnerable group of patients and to demonstrate how palliative care structures may help in supporting the care for patients with incurable haematological disease. On the other hand, this chapter will provide palliative care physicians and teams with a basis of knowledge on the biology, the therapy and the prognostic trajectories of different haematological entities, enabling those of us who work in specialised palliative care to specifically support these patients and understand the complex clinical situations that differ markedly from those encountered in patients with solid tumour entities.

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References

  • Ackroyd R, Russon L, Newell R (2007) Views of oncology patients, their relatives and oncologists on cardiopulmonary resuscitation (CPR): questionnaire-based study. Palliat Med 21:139–144

    Article  PubMed  Google Scholar 

  • Agarwal S, O’Donoghue S, Gowardman J, Kennedy G, Bandeshe H, Boots R (2012) Intensive care unit experience of hematopoietic stem cell transplant patients. Intern Med J 42(7):748–754

    Article  CAS  PubMed  Google Scholar 

  • Alibhai SMH, Leach M, Kowgier ME, Tomlinson GA, Brandwein JM, Minden MD (2007) Fatigue in older adults with acute myeloid leukaemia: predictors and associations with quality of life and functional status. Leukemia 21:845–848

    CAS  PubMed  Google Scholar 

  • Alt-Epping B, Simon A, Nauck F (2010) Blood product substitution in palliative care. Dtsch Med Wochenschr 135:2083–2087

    Article  CAS  PubMed  Google Scholar 

  • Alt-Epping B, Wulf G, Nauck F (2011) Palliative care for patients with hematological malignancies – a case series. Letter to the editor. Ann Hematol 90:613–615

    Article  PubMed Central  PubMed  Google Scholar 

  • Alt-Epping B, Hinse P, Lindena G, Nauck F (2014) To treat or not to treat patients with hematological malignancies in specialized palliative care institutions – results from two prospective surveys. Abstract P298 EAPC Research Congress, Lleida (Spain), 5.-7.06.2014. Palliat Med 28(6):743–744

    Google Scholar 

  • Ansell P, Howell D, Garry A, Kite S, Munro J, Roman E, Howard M (2007) What determines referral of UK patients with haematological malignancies to palliative care services? An exploratory study using hospital records. Palliat Med 21:487–492

    Article  PubMed  Google Scholar 

  • Auret K, Bulsara C, Joske D (2003) Australasian haematologist referral patterns to palliative care: lack of consensus of when and why. Intern Med J 33:566–571

    Article  CAS  PubMed  Google Scholar 

  • Beauchamp TL, Childress JF (2009) Principles of biomedical ethics, 6th edn. Oxford University Press, New York

    Google Scholar 

  • Benoit DD, Vandewoude KH, Decruyenaere JM, Hoste EA, Colardyn FA (2003) Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Crit Care Med 31(1):104–112

    Article  PubMed  Google Scholar 

  • Bonica JJ (1980) Cancer pain. In: Bonica JJ (ed) Pain. Raven, New York, pp 335–362

    Google Scholar 

  • Brown E, Bennett M (2007) Survey of blood transfusion practice for palliative care patients in Yorkshire: implications for clinical care. J Palliat Med 10:919–922

    Article  PubMed  Google Scholar 

  • Cheng W, Willey J, Palmer JL, Zhang T, Bruera E (2005) Interval between palliative care referral and death among patients treated at a comprehensive cancer center. J Palliat Med 8:1025–1032

    Article  PubMed  Google Scholar 

  • Chung HM, Lyckholm LJ, Smith TJ (2009) Palliative care in BMT. Bone Marrow Transplant 43:265–273

    Article  CAS  PubMed  Google Scholar 

  • Corbett CL, Johnstone M, McCracken Trauer J, Spruyt O (2013) Palliative care and hematological malignancies: increased referrals at a comprehensive cancer centre. J Palliat Med 16(5):537–541

    Article  PubMed  Google Scholar 

  • Demarosi F et al (2004) Transdermal fentanyl in HSCT patients: an open trial using transdermal fentanyl for the treatment of oral mucositis pain. Bone Marrow Transplant 33(12):1247–1251

    Article  CAS  PubMed  Google Scholar 

  • Epstein AS, Goldberg GR, Meier DE (2012) Palliative care and hematologic oncology: the promise of collaboration. Blood Rev 26:233–239

    Article  PubMed  Google Scholar 

  • Fadul NA, Elsayem A, Palmer JL, Zhang T, Braiteh F, Bruera E (2007) Predictors of access to palliative care services among patients who died at a comprehensive cancer center. J Palliat Med 10(5):1146–1152

    Article  PubMed  Google Scholar 

  • Fadul NA, El Osta B, Dalal S, Poulter VA, Bruera E (2008) Comparison of symptom burden among patients referred to palliative care with hematologic malignancies versus those with solid tumors. J Palliat Med 11(3):422–427

    Article  PubMed  Google Scholar 

  • Gordon AC, Oakervee HE, Kaya B, Thomas JM, Barnett MJ, Rohatiner AZ et al (2005) Incidence and outcome of critical illness amongst hospitalized patients with haematological malignancy: a prospective observational study of ward and intensive care unit based care. Anaesthesia 60:340–347

    Article  CAS  PubMed  Google Scholar 

  • Hampshire PA, Welch CA, McCrossan LA, Francis K, Harrison DA (2009) Admission factors associated with hospital mortality in patients with haematological malignancy admitted to UK adult, general critical care units: a secondary analysis of the ICNARC Case Mix Programme Database. Crit Care 13:R137

    Article  PubMed Central  PubMed  Google Scholar 

  • Heinonen H, Volin L, Zevon MA, Uutela A, Barrick C, Ruutu T (2005) Stress among allogeneic bone marrow transplantation patients. Patient Educ Couns 56:62–71

    Article  PubMed  Google Scholar 

  • Howell D, Shellens R, Roman E, Garry A, Patmore R, Howard M (2011) Haematological malignancy: are patients appropriately referred for specialist palliative and hospice care? A systematic review and meta-analysis of published data. Palliat Med 25(6):630–641

    Article  PubMed  Google Scholar 

  • Hui D, Didwaniya N, Vidal M, Shin SH, Chisholm G, Roquemore J, Bruera E (2014) Quality of end-of-life care in patients with hematologic malignancies: a retrospective cohort study. Cancer 15;120(10):1572–1578. doi:10.1002/cncr.28614. Epub 2014 Feb 18

  • Hung YS, Wu JH, Chang H, Wang PN, Kao CY, Wang HM, Liau CT, Chen JS, Lin YC, Su PJ, Hsieh CH, Chou WC (2013) Characteristics of patients with hematologic malignancies who received palliative care consultation services in a medical center. Am J Hosp Palliat Care 30:773–780

    Article  PubMed  Google Scholar 

  • Hunt RW, Fazekas BS, Luke CG, Priest KR, Roder DM (2002) The coverage of cancer patients by designated palliative services: a population-based study, South Australia, 1999. Palliat Med 16:403–409

    Article  PubMed  Google Scholar 

  • Husmann G, Kaatsch P, Katalinic A, Bertz J, Haberland J, Kraywinkel K, Wolf U (2010) Krebs in Deutschland 2005/2006. Häufigkeiten und Trends, 7th ed. http://www.rki.de/cln_226/nn_204124/DE/Content/GBE/DachdokKrebs/KID/kid__node.html?__nnn=true

  • Ibister J (1992) Palliative care: a clinical Haematologist’s view. Coff’s Harbour Palliative Care conference, Coff’s Harbour

    Google Scholar 

  • Jackson SR, Tweeddale MG, Barnett MJ, Spinelli JJ, Sutherland HJ, Reece DE, Klingemann HG, Nantel SH, Fung HC, Toze CL, Phillips GL, Shepherd JD (1998) Admission of bone marrow transplant recipients to the intensive care unit: outcome, survival and prognostic factors. Bone Marrow Transplant 21(7):697–704

    Article  CAS  PubMed  Google Scholar 

  • Joske D, McGrath P (2007) Palliative care in haematology. Intern Med J 37:589–590

    Article  CAS  PubMed  Google Scholar 

  • Kripp M, Willer A, Schmidt C, Pilz L, Gencer D, Buchheidt D, Hochhaus A, Hofmann WK, Hofheinz RD (2014) Patients with malignant hematological disorders treated on a palliative care unit: prognostic impact of clinical factors. Ann Hematol 93(2):317–325

    Article  CAS  PubMed  Google Scholar 

  • Krug U, Röllig C, Koschmieder A, Heinecke A, Sauerland MC, Schaich M, Thiede C, Kramer C, Braess J, Spiekermann K, Haferlach T, Haferlach C, Koschmieder S, Rohde C, Serve H, Wörmann B, Hiddemann W, Ehninger G, Berdel WE, BĂĽchner T, MĂĽller-Tidow C (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 376:2000–2008

    Article  CAS  PubMed  Google Scholar 

  • Lanken PN, Terry PB, American Thoracic Society End-of Life Task Force et al (2008) Palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med 177:912–927

    Article  PubMed  Google Scholar 

  • Maddocks I, Bentley L, Sheedy J (1994) Quality of life issues in patients dying from haematological diseases. Ann Acad Med Singapore 23(2):244–248

    CAS  PubMed  Google Scholar 

  • Manitta V, Philip J, Cole-Sinclair MF (2010) Palliative care and the hemato-oncological patient: can we live together? A review of the literature. J Palliat Med 13(8):1021–1025

    Article  PubMed  Google Scholar 

  • McGrath P (2001) Dying in the curative system: the haematology/oncology dilemma. Part 1. Aust J Holist Nurs 8:22–30

    CAS  PubMed  Google Scholar 

  • McGrath P (2002) Are we making progress? Not in haematology! Omega (Westport) 45(4):331–348

    Google Scholar 

  • McGrath P, Joske D (2002) Palliative care and haematological malignancy: a case study. Aust Health Rev 25(3):60–66

    Article  PubMed  Google Scholar 

  • Newton S (2003) Haematology and palliative care: blood, sweat and tears. Intern Med J 33(12):549–551

    Article  CAS  PubMed  Google Scholar 

  • Niscola P, Scaramucci L, Romani C, Giovannini M, Tendas A, Brunetti G, Cartoni C, Palumbo R, Vischini G, Siniscalchi A et al (2010) Pain management in multiple myeloma. Expert Rev Anticancer Ther 10:415–425

    Article  PubMed  Google Scholar 

  • Ostgathe C, Alt-Epping B, Golla H, Gaertner J, Lindena G, Radbruch L, Voltz R, Hospice and Palliative Care Evaluation (HOPE) Working Group in Germany (2011) Non-cancer patients in specialised palliative care in Germany: what are the problems? Palliat Med 25:148–152

    Article  PubMed  Google Scholar 

  • Radbruch L, Nauck F, Ostgathe C, Elsner F, Bausewein C, Fuchs M, Lindena G, Neuwohner K, Schulenberg D (2003) What are the problems in palliative care? Results from a representative survey. Support Care Cancer 11:442–451

    Article  PubMed  Google Scholar 

  • RKI, Robert Koch Institute (2013) Krebs in Deutschland. http://www.rki.de/Krebs/DE/Content/Publikationen/Krebs_in_Deutschland/kid_2013/krebs_in_deutschland_2013.pdf?__blob=publicationFile, Accessed 29.01.2015

  • Roze des Ordons AL, Chan K, Mirza I, Townsend DR, Bagshaw SM (2010) Clinical characteristics and outcomes of patients with acute myelogenous leukemia admitted to intensive care: a case-control study. BMC Cancer 10:516

    PubMed Central  PubMed  Google Scholar 

  • Sacha T1 (2014). Imatinib in chronic myeloid leukemia: an overview. Mediterr J Hematol Infect Dis 6(1). doi: 10.4084/MJHID.2014.007

  • Scales DC, Thiruchelvam D, Kiss A, Sibbald WJ, Redelmeier DA (2008) Intensive care outcomes in bone marrow transplant recipients: a population-based cohort analysis. Crit Care 12:R77

    Article  PubMed Central  PubMed  Google Scholar 

  • Slevin ML, Stubbs L et al (1990) Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public. BMJ 300(6737):1458–1460

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Solano JP, Gomes B, Higginson IJ (2006) A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manage 31:58–69

    Article  PubMed  Google Scholar 

  • Sorror ML, Sandmaier BM, Storer BE et al (2007) Comorbidity and disease status based risk stratification of outcomes among patients with acute myeloid leukemia or myelodysplasia receiving allogeneic hematopoietic cell transplantation. J Clin Oncol 25:4246–4254

    Article  PubMed  Google Scholar 

  • Staudinger T, Stoiser B, MĂĽllner M, Locker GJ, Laczika K, Knapp S, Burgmann H, Wilfing A, Kofler J, Thalhammer F, Frass M (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 28(5):1322–1328

    Article  CAS  PubMed  Google Scholar 

  • Tendas A, Niscola P, Cupelli L et al (2009) Palliative sedation therapy in a bone marrow transplant unit. Support Care Cancer 17:107–108

    Article  PubMed  Google Scholar 

  • World Health Organization (2002) WHO definition of palliative care. http://www.who.int/cancer/palliative/definition/en/

  • Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psychooncology 10:19–28

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Bernd Alt-Epping MD .

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Alt-Epping, B., Hohloch, K. (2015). Palliative Care for Patients with Haematological Malignancies. In: Alt-Epping, B., Nauck, F. (eds) Palliative Care in Oncology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-46202-7_3

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  • DOI: https://doi.org/10.1007/978-3-662-46202-7_3

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-46201-0

  • Online ISBN: 978-3-662-46202-7

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