Patients with haematological malignancy experience high rates of chemotherapy and supportive care use at the end of life, but many are only referred to palliative care a short time before death, according to findings presented at Blood 2023.
Dr Briony Shaw, a clinical and laboratory haematologist at Monash Health, Melbourne, and NHMRC-funded PhD candidate, said doctors needed to be mindful of deterioration in this patient group, especially for those not in hospital.
She said concurrent care with defined parameters for referral to specialist palliative care should be encouraged so that patients could receive disease modifying or even curative therapies alongside their symptom management and other supports.
Goals of care should also be established early beyond just resuscitation status, such as how much treatment the patient wants and even the location of death.
“Haematology patients differ from those with solid organ malignancy at end of life in which a lot of the literature is published,” Dr Shaw told delegates at the Melbourne meeting.
“Our patients often don’t have the traditional symptoms which more obviously trigger a referral to the palliative care team. However, physical and psychological symptoms are often present and symptoms such as fatigue often go unnoticed.
“Palliative care provides benefits such as psychological support to the patient and their family, access to other allied health and bereavement services after death.”
Study findings
Dr Shaw presented her retrospective study of 229 patients (median age 77 [range 24-99], 65% male) with haematological malignancies from five outer metropolitan hospitals in Melbourne who died between October 2019 and July 2022.
Of the patients, 58% were born overseas and 18% had non-English speaking backgrounds, with many cultures and religions represented, Dr Shaw noted.
Underlying haematological malignancies were predominantly acute myeloid leukaemia and aggressive B-cell lymphoma, including diffuse large B-cell lymphoma and Burkitt lymphoma, with myeloma and MDS also well represented.
Within 30 days of death, 65% presented to ED, 22% had an ICU admission and 22% had an invasive procedure, while 40% spent their last two weeks in hospital.
When it came to treatment and supportive care within 30 days of death, 61% had red cell transfusion, 48% had cytotoxic therapy and 46% had platelet transfusion.
Some 61% of patients had intravenous antibiotics in their last seven days.