Strategies for introducing palliative care in the management of relapsed or refractory aggressive lymphomas

Abstract

Recent advances in treatment of patients with aggressive lymphomas ranging from chimeric antigen receptor T-cell therapy to combination of antibody–drug conjugates with chemotherapy have improved survival outcomes. Despite these significant advances, patients with relapsed or refractory disease experience high physical and psychological symptom burden, and a substantial proportion still die of their lymphoma. In addition, end-of-life care outcomes are suboptimal with high rates of intensive end-of-life health care use and low rates of timely hospice enrollment. Integrating palliative care concurrently with disease-directed care for this patient population has strong potential to improve their symptom burden, quality of life, and end-of-life care. Multiple factors, including heightened prognostic uncertainty in the setting of relapsed/refractory disease, pose challenges to timely provision of palliative care. This article reviews benefits of primary and specialty palliative care for patients with relapsed/refractory aggressive lymphomas and barriers to such care. It also highlights strategies for effectively integrating palliative care for patients with relapsed/refractory aggressive lymphomas.

Need for integrating early palliative care with standard hematology care long before the allogeneic hemopoietic stem cells transplantation

“…Consistent with this, following integration of palliative with hematologic care, AML patients, undergoing intensive chemotherapy, showed significant improvements in quality of life and psychological distress, higher chances to discuss end-of-life care preferences, and reduced chemotherapy aggressiveness near end of life, compared with patients receiving usual care [7]. Communication skills are a pillar of an effective EPC intervention [8], and the training of dual board-certified medical hematologist/ palliative care physicians as well as other measures (Table 1) is essential to allow HSCT patients and caregivers to have a more realistic understanding of their disease trajectory and needs [8][9][10].…”

Palliative care of patients with haematological malignancies: strategies to overcome difficulties via integrated care

“…Examples for patients with multiple myeloma are provided by Ramsenthaler and colleagues, 34 approaches to palliative care for patients suffering from chronic graft versus host disease are provided by ElJawahri and colleagues, 35 and for patients with relapsed or refractory aggressive lymphomas by Odejide and colleagues. 36…”

Screening versus multidimensional assessment of symptoms and psychosocial distress in cancer patients from the time of incurability

“…There is abundant evidence from clinical studies that various quality of life (QoL) parameters and the implementation of patient's goals of care and preferences (1-3) may be improved by an early (timely) inclusion of a palliative care perspective in patients suffering from incurable cancers (4)(5)(6)(7)(8).…”

“…All these findings suggest the usefulness of a screening or assessment approach in order to gather these symptoms and needs in a timely and structured manner. ( 6 , 7 ).…”