1 Division of Hematology and Oncology, The University of North Carolina , Chapel Hill, North Carolina.
2 Palliative Care Program, Division of Geriatric Medicine, Center for Aging and Health, The University of North Carolina , Chapel Hill, North Carolina.
J Palliat Med. 2018 Feb;21(2):225-228. doi: 10.1089/jpm.2017.0097. Epub 2017 Aug 10.
Although strong evidence supports early palliative care (PC) and consistent advance care planning (ACP) for patients with poor-prognosis Stage IV solid tumors, best practice standards have not been established for hematologic malignancies. Our primary objective was to describe current access to specialty PC consultation and ACP for inpatients with high-risk leukemia. Secondary objectives were to describe components of ACP and PC practices.
We enrolled all patients with high-risk leukemia (acute leukemia ≥65 years or relapsed leukemia >18 years) admitted to the University of North Carolina Cancer Hospital from October 1, 2015, to August 1, 2016. Structured chart reviews provided data on demographics, disease characteristics, PC consultation, frequency and components of documented ACP, and quality measures for PC practices.
Of 50 high-risk leukemia patients, 52% were 65 years of age or older with a new diagnosis of acute leukemia and 48% were under the age of 65 with relapsed leukemia. Most patients (64%) reported pain on admission. Twenty-two percent of patients died within 3 months of hospitalization. Sixteen percent of patients received PC consultation and 24% had complete ACP, with an identified surrogate decision-maker documented treatment preferences.
In this descriptive study of inpatients with high-risk leukemia, we found that despite a poor prognosis and high symptom burden, the frequency of PC consultation and ACP documentation was low. Findings suggest missed opportunities to provide PC to a high-risk subset of hematologic malignancies, and may help to target future interventions.
尽管有强有力的证据支持对预后不佳的 IV 期实体瘤患者进行早期姑息治疗（PC）和持续的预先医疗指令（ACP），但血液恶性肿瘤的最佳实践标准尚未建立。我们的主要目标是描述高危白血病住院患者获得专科 PC 咨询和 ACP 的情况。次要目标是描述 ACP 和 PC 实践的组成部分。
我们纳入了 2015 年 10 月 1 日至 2016 年 8 月 1 日期间入住北卡罗来纳大学癌症医院的所有高危白血病（年龄≥65 岁的急性白血病或复发白血病＞18 岁）患者。结构化病历回顾提供了人口统计学、疾病特征、PC 咨询、记录的 ACP 频率和组成部分以及 PC 实践质量措施的数据。
在 50 名高危白血病患者中，52%的患者年龄在 65 岁或以上，新发急性白血病，48%的患者年龄在 65 岁以下，患有复发白血病。大多数患者（64%）入院时报告有疼痛。22%的患者在住院后 3 个月内死亡。16%的患者接受了 PC 咨询，24%的患者完成了 ACP，并记录了指定的代理人决策偏好。
在这项对高危白血病住院患者的描述性研究中，我们发现尽管预后较差且症状负担较重，但 PC 咨询和 ACP 记录的频率较低。研究结果表明，错过了为高危血液恶性肿瘤患者提供 PC 的机会，可能有助于确定未来的干预目标。
