Addressing End-of-Life Quality Gaps in Hematologic Cancers

LeBlanc, Thomas W.

doi:10.1001/jamainternmed.2015.6994

Cited by 40 publications

(8 citation statements)

References 7 publications

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“…This observation is consistent with the general under-use of palliative care services that has been noted in hematologic malignancies relative to solid tumor cancers. 16 Literature on the use of palliative care services in MDS is scant. A recent review suggested possible reasons for the divide between palliative care needs and medical practice in MDS may include clinical features of MDS that complicate recognizing end stage disease, misunderstanding of the intent or appropriateness of palliative care by hematologists in general, or misunderstanding of the efficacy of treatment for MDS by both patients and clinicians.…”

Section: Resultsmentioning

confidence: 99%

Patient-Reported Distress in Myelodysplastic Syndromes and Its Association With Clinical Outcomes: A Retrospective Cohort Study

Troy

Castro

Pupa

et al. 2018

J Natl Compr Canc Netw

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Purpose The National Comprehensive Cancer Network (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 given 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 ambulatory adult MDS patients visiting a single, tertiary care medical center from July 2013-September 2015. Demographic, diagnostic, treatment, and comorbidity information were abstracted from records along with the NCCN Distress Thermometer (DT) and Problem List (PL). 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/patient, range=1-16). NCCN guidelines suggest DT >=4 should be evaluated for referral to specialty services to address unmet needs. Fifty-four patients (49%) had at least 1 DT >=4 and 20 (18%) had 2 or more DT >=4. Ninety-eight 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 frequent 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% confidence interval: 1.01, 1.36). Conclusion MDS patients 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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Section: Resultsmentioning

confidence: 99%

Patient-Reported Distress in Myelodysplastic Syndromes and Its Association With Clinical Outcomes: A Retrospective Cohort Study

Troy

Castro

Pupa

et al. 2018

J Natl Compr Canc Netw

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“…Alternatively, this may reflect that HSCT patients enrolled in hospice are more willing to forgo transfusions despite ongoing transfusion needs. Yet, as data in hematologic malignancy and HSCT EOL care continues to grow, we continue to recognize how unique hematologic malignancy patients are from those with solid tumors [17]. Not only do HSCT patients have unique treatments and related side effects, but they have different symptom clusters and thus different palliative and hospice needs.…”

Section: Discussionmentioning

confidence: 99%

Transfusion practices at end of life for hematopoietic stem cell transplant patients

Wang

Joseph

Nelson

et al. 2017

Support Care Cancer

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“…Despite these barriers, a trend towards increased palliative care referral has been observed(22), along with a renewed call to examine the intersection between palliative care and the quality of life of blood cancer patients(23, 24), especially amid initial evidence of feasibility and efficacy in subpopulations such as those undergoing stem cell transplantations(25). These calls highlight the imperative to provide care across multiple domains of palliative care, including physical, psychological, spiritual, legal, and cultural aspects—for all patients with serious illness, even in hematology, amid greater prognostic uncertainty.…”

Section: Introductionmentioning

confidence: 99%

Comparing the Palliative Care Needs of Patients With Hematologic and Solid Malignancies

Hochman

Wolf

et al. 2018

Journal of Pain and Symptom Management

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Context Hematologic cancer patients use palliative care services less frequently than their solid tumor counterparts. Prior work suggests these patients have a sizeable symptom burden, but comparisons between hematologic and solid tumor patients near the end of life are limited. Objectives To compare unmet symptom needs in a cohort of hematologic and solid tumor patients referred to specialty palliative care services. Methods Using a novel data registry of initial palliative care encounters, we performed a cross-sectional analysis of cancer patients receiving care across seventeen sites within the Global Palliative Care Quality Alliance. We compared clinically-significant symptoms (rated as 4 or greater in severity) between hematologic and solid tumor patients and performed multivariate logistic regression analyses examining the relationship between symptom burden and tumor type. Results We identified 1,235 cancer patients, 108 of which had hematologic malignancies. Pain, dyspnea, nausea, and anorexia burden was as high among patients with hematologic as those with solid malignancies. Blood cancer patients had higher rates of clinically-significant tiredness (51% vs. 42%; p=0.03) than solid tumor patients. Finally, blood cancer patients had greater odds of being tired (odds ratio, 2.19; CI 1.22-3.91) and drowsy (odds ratio, 1.81; CI 1.07-3.07) than solid tumor patients independent of age, gender, race, and performance status. Conclusions Hematologic and solid tumor patients both have significant symptom burden at time of referral to palliative care services. Blood cancer patients may have unique concerns warranting targeted attention, including substantial drowsiness and tiredness. Our findings suggest a need to optimize palliative care usage in the hematologic cancer population.

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Addressing End-of-Life Quality Gaps in Hematologic Cancers

Cited by 40 publications

References 7 publications

Patient-Reported Distress in Myelodysplastic Syndromes and Its Association With Clinical Outcomes: A Retrospective Cohort Study

Patient-Reported Distress in Myelodysplastic Syndromes and Its Association With Clinical Outcomes: A Retrospective Cohort Study

Transfusion practices at end of life for hematopoietic stem cell transplant patients

Comparing the Palliative Care Needs of Patients With Hematologic and Solid Malignancies

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