Cheng Hon-Wai Benjamin, Li Cho-Wing, Chan Kwok-Ying, Au Ho-Yan, Chan Pan-Fong, Sin Yim-Ching, Szeto Yan, Sham Mau-Kwong
Palliative Medical Unit, Grantham Hospital, 125 Wong Chuk Hang Road, Aberdeen, Hong Kong, SAR, China,
Support Care Cancer. 2015 Jan;23(1):111-6. doi: 10.1007/s00520-014-2333-x. Epub 2014 Jul 5.
End-of-life care characteristics and palliative care (PC) utilization of elderly acute myeloid leukemia (AML) patients have rarely been reported. The aim of this study was to evaluate the cause of death, place of death and PC utilization of older adults (age 60 years or above) suffering from AML.
Patients were recruited retrospectively from two hematology units in Hong Kong, which consisted of one university department with Bone Marrow Transplant service, and one regional hospital with hematology specialty service. Collaboration with PC unit was established. Elderly AML patients referred to PC service were included. Medical records of all identified patients would be reviewed retrospectively by two PC physicians.
From October 2011 to April 2013, 156 hematological cancer patients were referred for PC; 43 elderly AML patients were included into data analysis. The median time from AML diagnosis to death was 9.1 months. Up to 46.5% patients received supportive care alone since diagnosis. More than half of elderly AML patients died in acute ward and hematology units (53.5 %), while 30.2 % died in PC settings. Overall, 51.2% of patients spent the whole period of their final month of life in-hospital. Infection-related diagnoses contributed to 51.2% of deaths. Median time from AML diagnosis to first PC consultation was 1.0 month. PC service includes psychosocial support (100%), hospice in-patient care (30.2%), homecare (60.5%), PC outpatient clinic (14.0%) and bereavement care (93.0%).
Elderly AML patients carry dismal prognosis with their final phase of disease mostly hospitalized in acute care settings. Infections and bleeding could complicate course of illness and lead to rapid deterioration. PC collaboration remains important in psychosocial support and coverage of dying AML patients in non-hospice settings.
老年急性髓系白血病（AML）患者的临终关怀特征及姑息治疗（PC）的使用情况鲜有报道。本研究旨在评估60岁及以上AML老年患者的死亡原因、死亡地点及PC的使用情况。
回顾性招募香港两家血液科的患者，其中一家是设有骨髓移植服务的大学科室，另一家是设有血液科专科服务的地区医院。与PC科室建立了合作关系。纳入转介至PC服务的老年AML患者。两名PC医生将对所有确诊患者的病历进行回顾性审查。
2011年10月至2013年4月，156例血液系统癌症患者被转介接受PC治疗；43例老年AML患者纳入数据分析。从AML诊断到死亡的中位时间为9.1个月。自诊断以来，高达46.5%的患者仅接受了支持性治疗。超过一半的老年AML患者在急性病房和血液科死亡（53.5%），而30.2%在PC环境中死亡。总体而言，51.2%的患者在生命最后一个月的整个期间都住院。与感染相关的诊断导致51.2%的死亡。从AML诊断到首次PC会诊的中位时间为1.0个月。PC服务包括心理社会支持（100%）、临终关怀住院护理（30.2%）、家庭护理（60.5%）、PC门诊（14.0%）和丧亲护理（93.0%）。
老年AML患者预后不佳，疾病终末期大多在急性护理环境中住院。感染和出血会使病程复杂化并导致病情迅速恶化。在心理社会支持以及对非临终关怀环境中临终AML患者的覆盖方面，PC合作仍然很重要。
