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Salazar MM, DeCook LJ, Butterfield RJ, Zhang N, Sen A, Wu KL, Vanness DJ, Khera N. End-of-Life Care in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation. J Palliat Med 2021; 25:97-105. [PMID: 34705545 DOI: 10.1089/jpm.2021.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Patients receiving allogeneic hematopoietic cell transplantation (HCT) have high morbidity and mortality risk, but literature is limited on factors associated with end-of-life (EOL) care intensity. Objectives: Describe EOL care in patients after allogeneic HCT and examine association of patient and clinical characteristics with intense EOL care. Design: Retrospective chart review. Setting/Subjects: A total of 113 patients who received allogeneic HCT at Mayo Clinic Arizona between 2013 and 2017 and died before November 2019. Measurements: A composite EOL care intensity measure included five markers: (1) no hospice enrollment, (2) intensive care unit (ICU) stay in the last month, (3) hospitalization >14 days in last month, (4) chemotherapy use in the last two weeks, and (5) cardiopulmonary resuscitation, hemodialysis, or mechanical ventilation in the last week of life. Multivariable logistic regression modeling assessed associations of having ≥1 intensity marker with sociodemographic and disease characteristics, palliative care consultation, and advance directive documentation. Results: Seventy-six percent of patients in our cohort had ≥1 intensity marker, with 43% receiving ICU care in the last month of life. Median hospital stay in the last month of life was 15 days. Sixty-five percent of patients died in hospice; median enrollment was 4 days. Patients with higher education were less likely to have ≥1 intensity marker (odds ratio 0.28, p = 0.02). Patients who died >100 days after HCT were less likely to have ≥1 intensity marker than patients who died ≤100 days of HCT (p = 0.04). Conclusions: Death within 100 days of HCT and lower educational attainment were associated with higher likelihood of intense EOL care.
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Affiliation(s)
- Marisa M Salazar
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Science and Medicine, Scottsdale, Arizona, USA
| | - Lori J DeCook
- Division of Hematology and Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | - Nan Zhang
- Department of Biostatistics, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Ayan Sen
- Department of Critical Care Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Kelly L Wu
- Division of General Internal Medicine, Center for Palliative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - David J Vanness
- Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Nandita Khera
- Division of Hematology and Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Polomeni A, Prod'homme C, Ainaoui M, Bellec A, Berr A, Bonneau J, Charbonnier A, Coiteux V, de Berranger E, Descamps T, Gire M, Goncalves M, Ruscassié A, Yakoub-Agha I, Borel C. [Palliative care in hematopoietic stem-cell transplanted patients: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2021; 108:S1-S9. [PMID: 34176584 DOI: 10.1016/j.bulcan.2021.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT), the only curative therapy for numerous hematological malignancies, carries a significant risk of morbidity and mortality. The patients and families' expectations regarding the procedure, the prognosis uncertainties, as well as the existence of potential new therapeutic possibilities, lead to frequent use of intensive care. Even though the transplant physicians are highly skilled in acute care, their knowledge of palliative approach is limited, making the use of palliative care insufficient and often late. By promoting reflection on the proportionality of care and the patients' quality of life, palliative care may contribute to the allo-HCT patients management. Nevertheless, obstacles to this approach remain. The objective of this work is to propose recommendations to promote the implementation of palliative care into transplant units.
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Affiliation(s)
- Alice Polomeni
- AP-HP, hôpital Saint-Antoine, service d'hématologie clinique et thérapie cellulaire, 184, rue du Faubourg Saint-Antoine, 75011 Paris, France.
| | - Chloé Prod'homme
- CHRU de Lille, clinique de médecine palliative, hôpital Calmette, 2, avenue Oscar-Lambret, 59037 Lille, France
| | - Malika Ainaoui
- CHRU de Lille, service des maladies du sang, avenue Michel-Polonovski, 59037 Lille cedex, France
| | - Adeline Bellec
- CHU de Rennes, service d'hématologie clinique, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - Aurélie Berr
- Institut de cancérologie Strasbourg Europe, service d'hématologie, 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg cedex, France
| | - Jacinthe Bonneau
- CHU de Rennes, hôpital Sud, service d'hématologie oncologie et greffe de moelle pédiatrique, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France
| | - Amandine Charbonnier
- CHU-groupe hospitalier Amiens-Sud, service d'hématologie clinique et thérapie cellulaire, 90054 Amiens cedex 1, France
| | - Valérie Coiteux
- CHRU de Lille, service des maladies du sang, avenue Michel-Polonovski, 59037 Lille cedex, France
| | - Eva de Berranger
- CHRU de Lille, hôpital Jeanne de Flandres, hématologie pédiatrique, avenue Eugène Avinée, 59037 Lille cedex, France
| | - Thomas Descamps
- CHRU de Lille, service des maladies du sang, avenue Michel-Polonovski, 59037 Lille cedex, France
| | - Marion Gire
- Institut de cancérologie Lucien Neuwirth, service d'hématologie, 104, avenue Albert-Raymond, 42270 Saint-Priest-en-Jarez, France
| | - Murielle Goncalves
- A.P.H.P., hôpital Saint-Antoine, service d'hématologie clinique et thérapie cellulaire, 184, rue du Faubourg Saint-Antoine, 75011 Paris, France
| | - Agnès Ruscassié
- Institut universitaire du cancer de Toulouse, département des soins de support, 1, avenue Irène Joliot-Curie, 31059 Toulouse cedex, France
| | | | - Cécile Borel
- Institut universitaire du cancer de Toulouse, service d'hématologie, 1, avenue Irène Joliot-Curie, 31059 Toulouse cedex, France
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Thompson LL, Chen ST, Lawton A, Charrow A. Palliative care in dermatology: A clinical primer, review of the literature, and needs assessment. J Am Acad Dermatol 2020; 85:708-717. [PMID: 32800870 DOI: 10.1016/j.jaad.2020.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 07/09/2020] [Accepted: 08/01/2020] [Indexed: 12/25/2022]
Abstract
Palliative care has been shown to improve quality of life, symptoms, and caregiver burden for a range of life-limiting diseases. Palliative care use among patients with severe dermatologic disease remains relatively unexplored, but the limited available data suggest significant unmet care needs and low rates of palliative care use. This review summarizes current palliative care patterns in dermatology, identifying areas for improvement and future investigation.
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Affiliation(s)
- Leah L Thompson
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Steven T Chen
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Andrew Lawton
- Harvard Medical School, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Alexandra Charrow
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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