Ruiz Marco, Reynolds Patrick, Marranzini Regina, Khan Alina, Ketterer Jessica, Brahim Amanda
1 Memorial Healthcare Department, Malignant Hematology & Cellular Therapy, FL, USA.
2 Memorial Healthcare System, Hollywood, FL, USA.
Am J Hosp Palliat Care. 2018 Nov;35(11):1456-1460. doi: 10.1177/1049909118772849. Epub 2018 Apr 26.
Despite advances in palliative care management of physical, psychological, and emotional symptoms along the spectrum of chronic conditions, early palliative care interventions are not used frequently and comprehensively in bone marrow transplant units.
The literature review of PubMed articles in English published until December 2017.
Patients with hematologic malignancies and bone marrow transplant interventions are a heterogeneous group. The majority experience symptoms associated with induction or condition regimens. Curative intent of treatment is the norm. Pain, mucositis, nausea and vomiting, diarrhea, psychological, spiritual, and emotional concerns may not be properly and comprehensively tackled by primary oncology and bone marrow transplant teams. Quality of life may be decreased due to the presence of these symptoms. Obstacles to early palliative care interventions include overestimation of survival, focus on curative intent with underestimation of palliative care needs, lack of a comprehensive understanding of hematologic malignancies and bone marrow transplant process on the side of palliative care providers, and logistical restrictions. Potential interventions include education of oncologists, palliative care providers, patients, integration of models of care pre- and posttreatment and bone marrow transplantation, development of guidelines, institutional commitment and leadership in creating new initiatives, clinical research activities to measure outcomes, and community-based participatory research.
Early palliative care interventions are beneficial for patients with hematologic malignancies and bone marrow transplant processes. Better understanding of barriers to its implementation and development of creative initiatives is of paramount importance. New research endeavors should focus on providers' attitudes toward patients and communities.
尽管在慢性病全病程的姑息治疗管理方面，针对身体、心理和情绪症状已取得进展，但早期姑息治疗干预措施在骨髓移植科室并未得到频繁且全面的应用。
对截至2017年12月发表的英文PubMed文章进行文献综述。
血液系统恶性肿瘤患者及骨髓移植干预措施涉及的人群具有异质性。大多数患者会经历与诱导治疗或病情治疗方案相关的症状。治疗以治愈为目的是常态。原发性肿瘤学和骨髓移植团队可能无法妥善且全面地处理疼痛、黏膜炎、恶心和呕吐、腹泻、心理、精神及情绪方面的问题。这些症状的存在可能会降低生活质量。早期姑息治疗干预措施面临的障碍包括对生存期的高估、专注于治愈目的而低估姑息治疗需求、姑息治疗提供者对血液系统恶性肿瘤及骨髓移植过程缺乏全面了解以及后勤限制。潜在的干预措施包括对肿瘤学家、姑息治疗提供者和患者进行教育，整合治疗前、治疗后及骨髓移植的护理模式，制定指南，机构在创建新举措方面的承诺和领导力，开展用于衡量结果的临床研究活动以及基于社区的参与性研究。
早期姑息治疗干预措施对血液系统恶性肿瘤患者及骨髓移植过程有益。更好地理解其实施障碍并开展创新性举措至关重要。新的研究工作应关注提供者对患者及社区的态度。
