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Kim DH, Youk J, Byun JM, Koh Y, Hong J, Kim TM, Kim I, Yoon SS, Yoo SH, Shin DY. Effects of tertiary palliative care on the pattern of end-of-life care in patients with hematologic malignancies in Korea. Eur J Haematol 2024; 112:743-755. [PMID: 38154958 DOI: 10.1111/ejh.14165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Patients with hematologic malignancies (HMs) often face challenges in accessing palliative care (PC) and receiving quality end-of-life (EOL) care. We examined factors associated with referrals to tertiary PC and the effects of tertiary PC on EOL care in patients with HMs. METHOD We included patients with HMs who were admitted to a university-affiliated hospital and died during hospitalization between January 2018 and December 2021. We investigated the receipt of PC consultations, patient characteristics, and EOL care indicators. RESULTS Overall, 487 patients were included in the analysis, with 156 (32%) undergoing PC consultation. Sex, residence, disease status, and admission purpose were factors associated with the likelihood of PC consultation, and there has been an increasing trend in the frequency of consultations in recent cases. A higher proportion of patients who received PC completed advance statements and life-sustaining treatment documents. Patients who received PC had lower rates of aggressive EOL care, including chemotherapy and intensive care unit admission, than those who did not receive PC. Notably, PC reduced the number of blood transfusions. CONCLUSION Tertiary PC aims to reduce aggressive EOL care through patient-centered goal-of-care discussions. Therefore, there is an imperative need for concerted efforts toward seamless integration of PC.
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Affiliation(s)
- Dong Hyun Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeonghwan Youk
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Junshik Hong
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Inho Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong-Yeop Shin
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
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Liu Z, Xu X, Ding K, Fu R. Quality of life considerations and management in patients with myelodysplastic syndrome. Expert Rev Hematol 2023; 16:849-860. [PMID: 37819160 DOI: 10.1080/17474086.2023.2268837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION This study aimed to identify the factors affecting the quality of life (QOL) and functional status of patients with MDS. AREAS COVERED We reviewed the literature published in PUBMED over the past 30 years and searched for keywords such as 'quality of life' and 'myelodysplastic syndromes'. By observing the influence of their symptoms, the possibility of improving patients' QOL was considered by improving these related factors. Concurrently, the effects of related clinical treatments based on the unique disease characteristics of MDS on the patients' QOL were examined, and lifestyle factors were considered in clinical practice, providing an important path to improve the QOL and functional status of patients with MDS. EXPERT OPINION This review summarized several areas that can improve the quality of survival of MDS patients and discusses them in depth. Although the clinical benefits may be minimal, we still hope to improve patients' daily life outcomes and enhance their quality of life at minimal cost. Also, we hope more researchers will focus on this area in the future to find more factors that may exist to supplement the limitations of these understanding and thinking, and to provide assistance in clinical work.
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Affiliation(s)
- Zhaoyun Liu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xintong Xu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Kai Ding
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
| | - Rong Fu
- Department of Hematology, Tianjin Medical University General Hospital, Tianjin, China
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Franjul Sánchez A, Fuentes Armesto AM, Briones Chávez C, Ruiz M. Revisiting Early Palliative Care for Patients With Hematologic Malignancies and Bone Marrow Transplant: Why the Delay? Cureus 2020; 12:e10504. [PMID: 32963924 PMCID: PMC7500707 DOI: 10.7759/cureus.10504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 11/12/2022] Open
Abstract
Palliative care has been defined as specialized care for patients facing serious illnesses. Despite advancements in the field and studies documenting the effectiveness of early palliative care (PC) interventions in seriously ill patients, the fields of hematologic malignancies and bone marrow transplant still lag behind of a comprehensive framework for early and effective interventions. The aim of this literature review is to analyze and discuss the possible barriers to care and delayed referrals for hematologic malignancies and bone marrow transplant patients. Using the EBSCO and PubMed databases, articles regarding PC among patients with hematologic malignancies and bone marrow transplant were analyzed. There are three main domains with its respective barriers in PC: physicians, patients and caregivers, and the healthcare system. Issues that were identified included the lack of knowledge and misconceptions about PC among physicians, patients, and caregivers, delayed referral of patients with hematologic malignancies, unrealistic treatment expectations, lack of communication between specialties, difficulties with appointment availability, geographical distance between clinics, and lack of insurance coverage for PC services. We suggest possible alternatives including obligatory continuing medical education (CME) credits, loan forgiveness, rotations during residency and fellowship training, use of informational videos and pamphlets to educate patients and caregivers, obligatory early consults despite prognosis, an algorithm to evaluate patient's needs, creating a platform within electronic medical records (EMR) systems shared by specialties, and having PC service in every cancer center. Findings suggest a need for further studies aimed towards implementing solutions to increase the early referral of patients with hematologic malignancies and bone marrow transplantation (BMT) to palliative care.
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Affiliation(s)
| | | | | | - Marco Ruiz
- Hematology and Oncology, Miami Cancer Institute, Miami, USA
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Troy JD, de Castro CM, Pupa MR, Samsa GP, Abernethy AP, LeBlanc TW. Patient-Reported Distress in Myelodysplastic Syndromes and Its Association With Clinical Outcomes: A Retrospective Cohort Study. J Natl Compr Canc Netw 2019. [PMID: 29523665 DOI: 10.6004/jnccn.2017.7048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: NCCN defines distress as a multifactorial, unpleasant emotional experience of a psychological nature that may interfere with patients' ability to cope with cancer symptoms and treatment. Patients with myelodysplastic syndromes (MDS) are at risk for distress due to the largely incurable nature of this hematopoietic malignancy and its symptom burden, yet associations with clinical outcomes are unknown. Methods: We retrospectively reviewed patient-reported distress data from adult ambulatory patients with MDS visiting a single, tertiary care medical center from July 2013 to September 2015. Demographic, diagnostic, treatment, and comorbidity information were abstracted from records along with NCCN Distress Thermometer (DT) and Problem List (PL) scores. Survival was analyzed using the Kaplan-Meier method and Cox proportional hazards regression. Results: We abstracted 376 DT scores (median, 1; range, 0-10) from 606 visits and 110 patients (median, 2 DT scores/patient; range, 1-16). NCCN Guidelines suggest that patients with DT scores ≥4 should be evaluated for referral to specialty services to address unmet needs. A total of 54 patients (49%) had at least 1 DT score ≥4 and 20 (18%) had 2 or more DT scores ≥4; 98 patients (89.1%) reported 1,379 problems during 23,613 person-days of follow-up (median, 4 problems/patient/visit; range, 1-23). The 5 most frequently reported problems were fatigue (181 times; 78 patients), pain (95 times; 46 patients), worry (80 times; 45 patients), sleep (78 times; 41 patients), and tingling hands/feet (68 times; 33 patients). After adjustment for risk stratification at diagnosis, a single point increase on the DT was associated with an increased risk of death (hazard ratio, 1.18; 95% CI, 1.01-1.36). Conclusions: Patients with MDS experience a high burden of distress, and patient-reported distress is associated with clinical outcomes. Distress should be further studied as a prognostic variable and a marker of unmet needs in MDS.
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Affiliation(s)
- Jesse D Troy
- From the Division of Blood and Marrow Transplantation, Department of Pediatrics, and Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine; Duke Cancer Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; and Data, Informatics and Statistics Core, Palliative Care Research Cooperative, Durham, North Carolina; and Flatiron Health, New York, New York
| | - Carlos M de Castro
- From the Division of Blood and Marrow Transplantation, Department of Pediatrics, and Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine; Duke Cancer Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; and Data, Informatics and Statistics Core, Palliative Care Research Cooperative, Durham, North Carolina; and Flatiron Health, New York, New York.,From the Division of Blood and Marrow Transplantation, Department of Pediatrics, and Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine; Duke Cancer Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; and Data, Informatics and Statistics Core, Palliative Care Research Cooperative, Durham, North Carolina; and Flatiron Health, New York, New York
| | - Mary Ruth Pupa
- From the Division of Blood and Marrow Transplantation, Department of Pediatrics, and Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine; Duke Cancer Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; and Data, Informatics and Statistics Core, Palliative Care Research Cooperative, Durham, North Carolina; and Flatiron Health, New York, New York
| | - Greg P Samsa
- From the Division of Blood and Marrow Transplantation, Department of Pediatrics, and Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine; Duke Cancer Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; and Data, Informatics and Statistics Core, Palliative Care Research Cooperative, Durham, North Carolina; and Flatiron Health, New York, New York.,From the Division of Blood and Marrow Transplantation, Department of Pediatrics, and Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine; Duke Cancer Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; and Data, Informatics and Statistics Core, Palliative Care Research Cooperative, Durham, North Carolina; and Flatiron Health, New York, New York
| | - Amy P Abernethy
- From the Division of Blood and Marrow Transplantation, Department of Pediatrics, and Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine; Duke Cancer Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; and Data, Informatics and Statistics Core, Palliative Care Research Cooperative, Durham, North Carolina; and Flatiron Health, New York, New York
| | - Thomas W LeBlanc
- From the Division of Blood and Marrow Transplantation, Department of Pediatrics, and Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine; Duke Cancer Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; and Data, Informatics and Statistics Core, Palliative Care Research Cooperative, Durham, North Carolina; and Flatiron Health, New York, New York.,From the Division of Blood and Marrow Transplantation, Department of Pediatrics, and Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine; Duke Cancer Institute; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; and Data, Informatics and Statistics Core, Palliative Care Research Cooperative, Durham, North Carolina; and Flatiron Health, New York, New York
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Boucher NA, Johnson KS, LeBlanc TW. Acute Leukemia Patients' Needs: Qualitative Findings and Opportunities for Early Palliative Care. J Pain Symptom Manage 2018; 55:433-439. [PMID: 28935132 DOI: 10.1016/j.jpainsymman.2017.09.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/08/2017] [Accepted: 09/10/2017] [Indexed: 12/20/2022]
Abstract
CONTEXT Patients with acute leukemias likely have needs that palliative care can respond to, yet little is known about specific challenges they face, particularly during active treatment. We examined acute myeloid leukemia (AML) patients' expressed challenges and supports after intensive induction chemotherapy. OBJECTIVES We aimed to understand opportunities for palliative care interventions in this population. METHODS We conducted a qualitative study of AML patients with high-risk disease at Duke University Hospital, Durham, NC. Patients were interviewed about care experiences approximately 3 months after treatment initiation. Multiple coders used descriptive content analysis to identify common and recurrent themes. RESULTS We analyzed 22 patient transcripts. Sample demographics included 10 (45.5%) females, 12 (54.5%) males, mean age 62 (SD 10.9), 19 (86.4%) non-Hispanic white, and three (13.6%) nonwhite/non-Hispanic. All had high-risk disease, by age, relapse status, or molecular markers. We identified four themes in our analysis: physical symptoms, psychological issues, uncertainty regarding prognosis, and patients' sources of support. Specific challenges noted by patients included feelings of helplessness/hopelessness, activity restriction, fatigue, fevers, caregiver stress, and lack of clarity regarding treatment decision making. CONCLUSION AML patients face substantial challenges regarding physical symptoms, psychological distress, and uncertainty regarding prognosis. These challenges signal needs for which palliative care in high-risk AML patients may help. Our findings highlight opportunities to develop targeted palliative care interventions addressing unmet needs in AML patients.
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Affiliation(s)
- Nathan A Boucher
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kimberly S Johnson
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
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