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Kayastha N, Kavanaugh AR, Webb JA, LeBlanc TW. Innovations for the integration of palliative care for hematologic malignancies. Curr Probl Cancer 2023; 47:101011. [PMID: 37718232 DOI: 10.1016/j.currproblcancer.2023.101011] [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: 07/19/2023] [Accepted: 08/10/2023] [Indexed: 09/19/2023]
Abstract
Specialist palliative care provides additional support to facilitate living well with a serious illness, like cancer, even while pursuing disease-directed therapy. For patients with hematologic malignancies, integrated specialist palliative care improves symptom burden, mood, and quality of life, with benefits even extending to caregivers. Despite this, patients with hematologic malignancies continue to have significant unmet palliative care needs and typically access palliative care late in their disease trajectories, if at all. In this paper, we will define specialist palliative care and review its benefits for patients with hematologic malignancies. We will discuss the unmet palliative care needs of this patient population and the barriers to integrating palliative care and oncologic care. Finally, we will explore innovations and areas of future research to enhance and optimize palliative care integration into usual cancer care treatment for patients with hematologic malignancies. We will explore the importance of ongoing clinical trials that are examining the correct "dose" of palliative care; the use of technology and telehealth; and the use of novel treatments for this patient population. Together, we will consider innovative avenues to provide palliative care to patients with hematologic malignancies and their caregivers.
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Affiliation(s)
- Neha Kayastha
- Section of Palliative Care, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC.
| | - Alison R Kavanaugh
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA
| | - Jason A Webb
- Section of Palliative Care, Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC
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Kayastha N, LeBlanc TW. Palliative care for patients with hematologic malignancies: are we meeting patients' needs early enough? Expert Rev Hematol 2022; 15:813-820. [PMID: 36062508 DOI: 10.1080/17474086.2022.2121696] [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: 11/04/2022]
Abstract
INTRODUCTION Palliative care for patients with cancer, and more recently for patients with hematologic malignancies, has increasingly been shown to be beneficial, with mounting evidence pointing to its vast benefits both to patients and caregivers. Despite this, there is a significant gap in integration of palliative care into usual cancer care for patients with hematologic malignancies. AREAS COVERED In this paper, we will define palliative care and discuss its benefits broadly for patients with hematologic malignancies. We will then discuss the late access to palliative care, the unmet needs in this patient population, and some of the barriers to access to palliative care. EXPERT OPINION With all this information and the clear benefit for early integrated palliative care for patients with hematologic malignancies, there is a need for novel models of palliative care and cancer care integration. Given the various needs of patients with different hematologic malignancies, we propose how palliative care can meet the unique needs of patients with hematologic malignancy by disease subtype.
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Affiliation(s)
- Neha Kayastha
- Department of Medicine, Duke University School of Medicine
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine.,Duke Cancer Institute
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Intensity of care in cancer patients in the last year of life: a retrospective data linkage study. Br J Cancer 2022; 127:712-719. [PMID: 35545681 PMCID: PMC9092325 DOI: 10.1038/s41416-022-01828-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background Delivering high-quality palliative and end-of-life care for cancer patients poses major challenges for health services. We examine the intensity of cancer care in England in the last year of life. Methods We included cancer decedents aged 65+ who died between January 1, 2010 and December 31, 2017. We analysed healthcare utilisation and costs in the last 12 months of life including hospital-based activities and primary care. Results Healthcare utilisation and costs increased sharply in the last month of life. Hospital costs were the largest cost elements and decreased with age (0.78, 95% CI: 0.73–0.72, p < 0.005 for age group 90+ compared to age 65–69 and increased substantially with comorbidity burden (2.2, 95% CI: 2.09–2.26, p < 0.005 for those with 7+ comorbidities compared to those with 1–3 comorbidities). The costs were highest for haematological cancers (1.45, 95% CI: 1.38–1.52, p < 0.005) and those living in the London region (1.10, 95% CI: 1.02–1.19, p < 0.005). Conclusions Healthcare in the last year of life for advanced cancer patients is costly and offers unclear value to patients and the healthcare system. Further research is needed to understand distinct cancer populations’ pathways and experiences before recommendations can be made about the most appropriate models of care.
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Kayastha N, LeBlanc TW. Why Are We Failing to Do What Works? Musings on Outpatient Palliative Care Integration in Cancer Care. JCO Oncol Pract 2021; 18:255-257. [PMID: 34936378 DOI: 10.1200/op.21.00794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Neha Kayastha
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC.,Duke Cancer Institute, Durham, NC
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Tanzi S, Venturelli F, Luminari S, Merlo FD, Braglia L, Bassi C, Costantini M. Early palliative care in haematological patients: a systematic literature review. BMJ Support Palliat Care 2020; 10:395-403. [DOI: 10.1136/bmjspcare-2020-002386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/24/2020] [Accepted: 09/04/2020] [Indexed: 12/29/2022]
Abstract
BackgroundEarly palliative care together with standard haematological care for advanced patients is needed worldwide. Little is known about its effect. The aim of the review is to synthesise the evidence on the impact of early palliative care on haematologic cancer patients’ quality of life and resource use.Patients and methodsA systematic review was conducted. The search terms were early palliative care or simultaneous or integrated or concurrent care and haematological or oncohaematological patients. The following databases were searched: PubMed, Embase, Cochrane, CINHAL and Scopus. Additional studies were identified through cross-checking the reference articles. Studies were in the English language, with no restriction for years. Two researchers independently reviewed the titles and abstracts, and one author assessed full articles for eligibility.ResultsA total of 296 studies titles were reviewed. Eight articles were included in the synthesis of the results, two controlled studies provided data on the comparative efficacy of PC interventions, and six one-arm studies were included. Since data pooling and meta-analysis were not possible, only a narrative synthesis of the study results was performed. The quality of the two included comparative studies was low overall. The quality of the six non-comparative studies was high overall, without the possibility of linking the observed results to the implemented interventions.ConclusionsStudies on early palliative care and patients with haematological cancer are scarce and have not been prospectively designed. More research on the specific population target, type and timing of palliative care intervention and standardisation of collected outcomes is required.PROSPERO registration numberCRD42020141322.
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Chalopin T, Vallet N, Benboubker L, Ochmann M, Gyan E, Chaumier F. Retrospective review of end-of-life care in the last month of life in older patients with multiple myeloma: what collaboration between haematologists and palliative care teams? BMJ Support Palliat Care 2020:bmjspcare-2020-002293. [PMID: 32887726 DOI: 10.1136/bmjspcare-2020-002293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/24/2020] [Accepted: 07/31/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Patients with haematological malignancies (HM) receive more aggressive treatments near the end-of-life (EOL) than patients with solid tumours. Palliative care (PC) needs are less widely acknowledged in patients with multiple myeloma (MM) than in other HM. The main objective of our study was to describe EOL care and PC referral in a population of older patients with MM. METHODS We retrospectively included deceased inpatients and outpatients with an MM previously diagnosed at the age of 70 and over in two tertiary centres in France. We reported EOL characteristics regarding treatments considered to be aggressive-antimyeloma therapies, hospitalisations, blood product transfusions, intensive care units (ICUs) or emergency admissions-and PC referral. RESULTS We included 119 patients. In their last month of life, 75 (63%) were hospitalised for fever, pain, asthenia, anaemia or bleeding, 49 (41%) were admitted in the emergency department and 12 (10%) in ICU, 76 (64%) still received antimyeloma therapy and 45 (38%) had at least two transfusions. Only 24 (20%) received PC intervention for pain, global care, family support, anxiety, social care or confusion. Median follow-up until death was 20 days. CONCLUSIONS Our study found a high rate of hospitalisations and antimyeloma therapies in the last month of life. The PC referral rate was low, often once specific treatments were stopped. Our results suggest the need for more effective collaboration between PC teams and haematologists in order to respond to the specific needs of these patients and to improve their quality of care at EOL.
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Affiliation(s)
- Thomas Chalopin
- Department of Haematology and Cell Therapy, Regional University Hospital Centre Tours, Tours, Centre-Val de Loire, France
| | - Nicolas Vallet
- Department of Haematology and Cell Therapy, Regional University Hospital Centre Tours, Tours, Centre-Val de Loire, France
| | - Lotfi Benboubker
- Department of Haematology and Cell Therapy, Regional University Hospital Centre Tours, Tours, Centre-Val de Loire, France
| | - Marlène Ochmann
- Department of Haematology, Regional Hospital Centre Orleans, Orleans, Centre-Val de Loire, France
| | - Emmanuel Gyan
- Department of Haematology and Cell Therapy, Regional University Hospital Centre Tours, Tours, Centre-Val de Loire, France
- CNRS ERL 7001 LNOx (Leukemic Niche & redOx metabolism), Université de Tours, Tours, Centre-Val de Loire, France
| | - François Chaumier
- Palliative Care Team, Regional University Hospital Centre Tours, Tours, Centre-Val de Loire, France
- UMR INSERM U1246 SPHERE (methodS in Patients-centered outcomes and HEalth ResEarch), Université de Tours, Tours, Centre-Val de Loire, France
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Bharadwaj P, Snoussi L, Caso C, Sonbol E, Lim S, Lill M. Aligning Palliative Care with Cure: Experience of Integrating with Hematopoietic Stem Cell Transplant. J Palliat Med 2020; 23:162-163. [PMID: 32023192 DOI: 10.1089/jpm.2019.0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Laura Snoussi
- Oncology Field Medical, Novartis, East Hanover, New Jersey
| | - Carolina Caso
- Department of Pharmacy Services, IPSEN Pharma, Brisbane, California
| | - Eyman Sonbol
- Clinical Nursing, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stephen Lim
- Oncology Field Medical, Novartis, East Hanover, New Jersey
| | - Michael Lill
- Clinical Nursing, Cedars-Sinai Medical Center, Los Angeles, California
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Webb JA, LeBlanc TW, El-Jawahri AR. Integration of Palliative Care into Acute Myeloid Leukemia Care. Semin Oncol Nurs 2019; 35:150959. [PMID: 31767262 DOI: 10.1016/j.soncn.2019.150959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To provide an overview of the past, present, and future of the integration of palliative care services for patients with hematologic malignancies, such as acute myeloid leukemia (AML). DATA SOURCES Published literature as indexed in Medline, relevant guideline documents, textbooks, and clinical experience. CONCLUSION Patients with acute leukemias have substantial palliative care needs that often go unmet with standard oncology care. Evidence shows that the early integration of specialist palliative care into standard oncology care improves patient-centered outcomes among those with advanced solid tumors. Emerging evidence supports similar benefits among hospitalized patients with hematologic malignancies undergoing stem cell transplantation, and additional trials are underway to further test palliative care interventions in patients with AML. IMPLICATIONS FOR NURSING PRACTICE By better understanding the palliative care needs of patients with AML and the evidence of integration with standard oncologic care, patients with leukemias may be more likely to receive early integrated palliative care.
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Affiliation(s)
- Jason A Webb
- Duke Palliative Care, Duke University and Health System, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC.
| | - Thomas W LeBlanc
- Department of Medicine, Duke University School of Medicine, Durham, NC; Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC; Duke Cancer Institute, Durham, NC
| | - Areej R El-Jawahri
- Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
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