Early Palliative Care in Acute Myeloid Leukemia

Huang

et al. 2023

Cancers

Background: Information on the use of palliative care and aggressive treatments for terminally ill patients who receive care from hospitalists is limited. Methods: This three-year, retrospective, case-control study was conducted at an academic medical center in Taiwan. Among 7037 patients who died in the hospital, 41.7% had a primary diagnosis of cancer. A total of 815 deceased patients who received hospitalist care before death were compared with 3260 patients who received non-hospitalist care after matching for age, gender, catastrophic illness, and Charlson comorbidity score. Regression models with generalized estimating equations were performed. Results: Patients who received hospitalist care before death, compared to those who did not, had a higher probability of palliative care consultation (odds ratio (OR) = 3.41, 95% confidence interval (CI): 2.63–4.41), and a lower probability to undergo invasive mechanical ventilation (OR = 0.13, 95% CI: 0.10–0.17), tracheostomy (OR = 0.14, 95% CI: 0.06–0.31), hemodialysis (OR = 0.70, 95% CI: 0.55–0.89), surgery (OR = 0.25, 95% CI: 0.19–0.31), and intensive care unit admission (OR = 0.11, 95% CI: 0.08–0.14). Hospitalist care was associated with reductions in length of stay (coefficient (B) = −0.54, 95% CI: −0.62–−0.46) and daily medical costs. Conclusions: Hospitalist care is associated with an improved palliative consultation rate and reduced life-sustaining treatments before death.

Section: Discussionmentioning

confidence: 99%

Does Hospitalist Care Enhance Palliative Care and Reduce Aggressive Treatments for Terminally Ill Patients? A Propensity Score-Matched Study

Huang

et al. 2023

Cancers

“…Patients with ALL may achieve complete or partial remission following CAR T-cell therapy but the risk of relapse is still high. 91 Hence, PRO measures could also be implemented in a more standardized way in the context of the model of integration of early palliative care with standard hematologic care as recently implemented for hematologic malignancies, [92][93][94] to more accurately engage patients in goals-of-care discussion, earlier in the disease course based on effective communication. 92 The relationship between the financial burden experienced by these patients and HRQoL outcomes over the long-term period is also an important aspect that deserves special consideration.…”

Section: Discussionmentioning

confidence: 99%

Chimeric Antigen Receptor T-cell Therapy in Hematologic Malignancies and Patient-reported Outcomes: A Scoping Review

et al. 2022

Self Cite

The inclusion of patient-reported outcome (PRO) measures in chimeric antigen receptor (CAR) T-cell therapy research is critical for understanding the impact of this novel approach from a unique patient standpoint. We performed a scoping review to map the available literature on the use of PRO measures in CAR T-cell therapy studies of patients with hematologic malignancies published between January 2015 and July 2022. Fourteen studies were identified, of which 7 (50%) were investigational early-phase trials, 6 (42.9%) were observational studies, and 1 (7.1%) was a pilot study. The EQ-5D and the PROMIS-29 were the 2 most frequently used PRO measures, being included in 6 (42.9%) and 5 (35.7%) studies, respectively. Despite differences in study designs, there seems to be evidence of improvements over time since CAR T-cell infusion in important domains such as physical functioning and fatigue, at least in patients who respond to therapy. Overall, the studies identified in our review have shown the added value of PRO assessment in CAR T-cell therapy research by providing novel information that complements the knowledge on safety and efficacy. However, there are several questions which remain to be answered in future research. For example, limited evidence exists regarding patient experience during important phases of the disease trajectory as only 4 (28.6%) and 5 (35.7%) studies provided information on PROs during the first 2 weeks from CAR T-cell infusion and after the first year, respectively. Time is ripe for a more systematic implementation of high-quality PRO assessment in future clinical trials and in real-life settings of patients treated with CAR T-cell therapy.

“…Also for rare treatable hematologic malignancies [ 19 ] such as Acute Myeloid Leukemia [ 20 ] and Chronic Myeloid Leukemia [ 21 ] palliative care plans have been published. More recent publications appeared in the literature about palliative care for rare cancers with an orphan drug authorization such as multiple myeloma [ 22 , 23 ], rare lymphomas [ 24 ], myelodysplastic syndromes [ 25 ] and soft tissue sarcomas [ 26 ].…”

Section: Methodsmentioning

confidence: 99%

Pharmacists are initiators in palliative care for patients with rare diseases

Dooms¹

2023

Orphanet J Rare Dis

The World Health Organization supports early delivery of palliative care as it reduces unnecessary hospital admissions and the inappropriate use of health care services. A community pharmacist can play a key role in advocating timely access to palliative care. Medication reconciliation must alert them to start communicating with the patient and/or his relatives about refocusing treatment and care as part of palliative and terminal care. Pharmaceutical activities for these patients include dispensing of devices and medicinal products, compounding personalized medication and participating as a member of the Palliative Support Team. Most of the several thousands of rare diseases are caused by genetic defects and up to now have no cure and a late diagnosis.