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Review
. 2020 Mar 20;38(9):944-953.
doi: 10.1200/JCO.18.02386. Epub 2020 Feb 5.

Palliative and End-of-Life Care for Patients With Hematologic Malignancies

Areej El-Jawahri  1   2 , Ashley M Nelson  1   2 , Tamryn F Gray  2   3 , Stephanie J Lee  4 , Thomas W LeBlanc  5
Affiliations
Review

Palliative and End-of-Life Care for Patients With Hematologic Malignancies

Areej El-Jawahri et al. J Clin Oncol. .

Abstract

Hematologic malignancies are a heterogeneous group of diseases with unique illness trajectories, treatment paradigms, and potential for curability, which affect patients' palliative and end-of-life care needs. Patients with hematologic malignancies endure immense physical and psychological symptoms because of both their illness and often intensive treatments that result in significant toxicities and adverse effects. Compared with patients with solid tumors, those with hematologic malignancies also experience high rates of hospitalizations, intensive care unit admissions, and in-hospital deaths and low rates of referral to hospice as well as shorter hospice length of stay. In addition, patients with hematologic malignancies harbor substantial misperceptions about treatment risks and benefits and frequently overestimate their prognosis. Even survivors of hematologic malignancies struggle with late effects, post-treatment complications, and post-traumatic stress symptoms that can significantly diminish their quality of life. Despite these substantial unmet needs, specialty palliative care services are infrequently consulted for the care of patients with hematologic malignancies. Several illness-specific, cultural, and system-based barriers to palliative care integration and optimal end-of-life care exist in this population. However, recent evidence has demonstrated the feasibility, acceptability, and efficacy of integrating palliative care to improve the quality of life and care of patients with hematologic malignancies and their caregivers. More research is needed to develop and test population-specific palliative and supportive care interventions to ensure generalizability and to define a sustainable clinical delivery model. Future work also should focus on identifying moderators and mediators of the effect of integrated palliative care models on patient-reported outcomes and on developing less resource-intensive integrated care models to address the diverse needs of this population.

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Conflict of interest statement

Palliative and End-of-Life Care for Patients With Hematologic Malignancies

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/journal/jco/site/ifc.

Stephanie J. Lee

Honoraria: Mallinckrodt

Consulting or Advisory Role: Incyte, Pfizer, EMD Serono (I), Pfizer (I), Kadmon, MSD Oncology (I), Sanofi (I), Genzyme (I), Regeneron Pharmaceuticals (I)

Research Funding: Kadmon, Takeda Pharmaceuticals, Amgen, Bristol-Myers Squibb (I), EMD Serono (I), Merck Sharp & Dohme (I)

Patents, Royalties, Other Intellectual Property: Patent pending for high-affinity T-cell receptors that target the Merkel polyomavirus (I)

Travel, Accommodations, Expenses: Mallinckrodt, Incyte

Thomas W. LeBlanc

Honoraria: Celgene, Helsinn Therapeutics, Quintiles

Consulting or Advisory Role: Flatiron Health, Helsinn Therapeutics, Otsuka, Heron, Amgen, Seattle Genetics, Pfizer, Agios, AbbVie, Genentech, Medtronic, AstraZeneca

Research Funding: Seattle Genetics (Inst), AstraZeneca (Inst)

Travel, Accommodations, Expenses: Celgene, Otsuka, Heron, Amgen, Agios, AbbVie, Genentech

No other potential conflicts of interest were reported.

Figures

FIG 1.
FIG 1.
Barriers to palliative care use in patients with hematologic malignancies. EOL, end of life.
FIG 2.
FIG 2.
Barriers to optimal end-of-life (EOL) care for patients with hematologic malignancies.
FIG 3.
FIG 3.
Potential strategies for palliative care (PC) integration in patients with hematologic malignancies. Note that the diseases included here are only examples and do not represent a comprehensive list of hematologic malignancies.
See this image and copyright information in PMC

Comment in

References

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