Palliative Care Service, St Vincent's Hospital, Melbourne, Victoria, Australia.
J Palliat Med. 2010 Aug;13(8):1021-5. doi: 10.1089/jpm.2009.0267.
Current evidence suggests that patients with hematological malignancies less frequently access palliative care services, and for those who do, this tends to occur later in their illness than their counterparts with solid malignancies. These patients are also more likely to die in hospital following escalating interventions. This approach to care that considers palliative care referral after most treatments are exhausted has implications for the quality of palliative care intervention possible. An episodic approach engaging palliative care according to needs rather than prognosis may be more valuable. The successful integration of palliative care into the care of hemato-oncological patients requires recognition by palliative care physicians of the particular issues encountered in care, namely, the difficulty in individual prognostication; ongoing therapeutic goals of curability or long term survival; the technical nature and complications of treatment; the speed of change to a terminal event; the need for pathology testing and transfusion of blood products as death approaches; the potentially reversible nature of intercurrent events such as infection; and the long relationships that develop between patients and their hematologists. Meanwhile, hematologists should be aware of the benefits of palliative care earlier in an illness trajectory and that palliative care does not equate to terminal care only. This review summarizes current practices and barriers to referral, and suggests recommendations for collaborative care and further research in the palliation of hemato-oncological patients. In doing so, it highlights to palliative care and hematology physicians how successful integration of their disciplines may improve their care of these patients.
目前的证据表明，血液系统恶性肿瘤患者较少接受姑息治疗服务，而对于那些接受姑息治疗的患者，他们的病情往往比实体恶性肿瘤患者更晚。这些患者在接受更多治疗后，更有可能在医院死亡。这种在大多数治疗方法用尽后才考虑姑息治疗的方法，对姑息治疗干预的质量有影响。根据需要而不是预后来进行姑息治疗的偶发性方法可能更有价值。姑息治疗成功地融入血液肿瘤患者的治疗中，需要姑息治疗医生认识到护理中遇到的特殊问题，即个体预后的困难；可治愈或长期生存的持续治疗目标；治疗的技术性质和并发症；向终末期事件的快速转变；接近死亡时需要进行病理学检查和输血；感染等并发事件可能具有可逆性；以及患者与其血液学家之间发展起来的长期关系。同时，血液学家应该更早地意识到姑息治疗的益处，并且知道姑息治疗并不等同于临终关怀。这篇综述总结了目前的实践和转诊障碍，并提出了协作护理和进一步研究血液肿瘤患者姑息治疗的建议。这样做，向姑息治疗和血液学医生强调了他们的学科成功整合可能会如何改善他们对这些患者的护理。
