LeBlanc Thomas W, Roeland Eric J, El-Jawahri Areej
Duke Cancer Institute, Durham, NC, USA.
Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
Curr Hematol Malig Rep. 2017 Aug;12(4):300-308. doi: 10.1007/s11899-017-0392-z.
Evidence points to many benefits of "early palliative care," the provision of specialist palliative care services upstream from the end of life, to improve patients' quality of life while living with a serious illness. Yet most trials of early palliative care have not included patients with hematologic malignancies. Unfortunately, patients with hematologic malignancies are also known to have substantial illness burden, poor quality of life, and aggressive care at the end of life, including a greater likelihood of dying in the hospital, receiving chemotherapy at the end of life, and low hospice utilization, compared to patients with solid tumors. Given these unmet needs, one must wonder, why is palliative care so underutilized in this population? In this article, we discuss barriers to palliative care integration in hematology, highlight several reports of successful integration, and suggest specific indications for involving palliative care in the management of hematologic malignancy patients.
有证据表明，“早期姑息治疗”具有诸多益处。早期姑息治疗是指在生命末期之前提供专科姑息治疗服务，以提高重症患者的生活质量。然而，大多数早期姑息治疗试验并未纳入血液系统恶性肿瘤患者。不幸的是，与实体瘤患者相比，血液系统恶性肿瘤患者也存在疾病负担重、生活质量差以及生命末期积极治疗的情况，包括在医院死亡的可能性更大、生命末期接受化疗以及临终关怀利用率低等问题。鉴于这些未得到满足的需求，人们不禁要问，为什么姑息治疗在这一人群中如此未得到充分利用？在本文中，我们讨论了血液学中姑息治疗整合的障碍，强调了一些成功整合的报告，并提出了在血液系统恶性肿瘤患者管理中纳入姑息治疗的具体指征。
