Supportive care and symptom management in patients with advanced hematological malignancies: a literature review

Abstract

Background and Objective: Recent advances have led to cure or long-term disease control for patients with hematological malignancy (HM). Unfortunately, some of them still have poor prognoses and are often associated with significant symptom burden and poor quality of life for patients and families. These patients usually require supportive care including red blood cell and platelet transfusion, due to disease itself and the oncological treatment, apart from their symptom management. However, there is currently lack of the literatures review in these aspects. The objective of this review is to summarize practical supportive care recommendations for physicians or nurses practicing in palliative care (PC)/hematology-oncology unit, starting with core approaches in use of blood products for anemia and thrombocytopenia, management of tumor lysis syndrome, PC and oncology nursing care.

Complexities in delivering end-of-life care in accordance with patient desires that have been documented

“…This is particularly important in complex acute care settings when a number of medical teams collaborate on patient care and treatment choices. Much has to be done to mainstream ACP conversations and educate the public about its advantages (17). Even though it might not always be possible or wise to provide EOL care in accordance with their preferences, future ACP programs should involve physicians and families for ongoing conversations, frequently update patients' ACP documents, include clear and well-resourced plans for implementing patients' preferences, and incorporate a well-designed and flexible electronic system to capture ongoing or incomplete conversations.…”

Palliative care for patients with hematological malignancies—beyond specialist care

“…Both PC specialty and hemato-oncology teams will benefit from a better understanding of the unique physical, psychosocial and spiritual challenges facing HM patients and clinicians and how they may be addressed. A recent study by Chan et al describes the landscape of PC challenges in the setting of HM and review recommendations for the supportive and PC of these patients (11). The review includes issues critical to HM such as transfusions of blood products, infection management and use of growth factors as well as more general issues such as symptom management all of which may serve hemato-oncology teams seeking to improve PC skills.…”

Improving quantity and quality of life: supportive and palliative care for patients with advanced hematologic malignancies

“…In addition, as Franjul Sánchez et al (22) describe, bidirectional training and collaboration among PC and hemato-oncology clinicians may be helpful. Indeed, Chan et al (10) present their article as a resource/guide for both PC and hematooncology clinicians. Further, education on PC for patients and family caregivers may also help to erode some of the misperceptions and stigma associated with PC (25).…”

“…Further, education on PC for patients and family caregivers may also help to erode some of the misperceptions and stigma associated with PC (25). Finally, as Chan et al (10) describe, hemato-oncology clinicians should possess basic PC competencies and skills to be able to provide primary PC and adopt a palliative approach to care. Along with more education on PC, research on PC for patients with HMs is also needed.…”

“…Perhaps somewhat unique to advanced HMs, patients with HMs may require and benefit from transfusion support throughout the disease trajectory, even at EOL, as articulated by Chan et al (10). In some jurisdictions, hospice agencies may not permit transfusion support, even if the intent is to relieve symptoms, due to logistics and costs (19); this has been reported to be a potential barrier to referring patients with HMs to PC.…”