Emory University School of Medicine, Atlanta, GA, USA.
Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA.
Cancer Med. 2021 Apr;10(8):2714-2722. doi: 10.1002/cam4.3862. Epub 2021 Mar 22.
Despite favorable prognoses, pediatric patients with hematologic malignancies experience significant challenges that may lead to diminished quality of life or family stress. They are less likely to receive subspecialty palliative care (PC) consultation and often undergo intensive end-of-life (EOL) care. We examined "palliative opportunities," or events when the integration of PC would have the greatest impact, present during a patient's hematologic malignancy course and relevant associations.
A single-center retrospective review was conducted on patients aged 0-18 years with a hematologic malignancy who died between 1/1/12 and 11/30/17. Demographic, disease, and treatment data were collected. A priori, nine palliative opportunity categories were defined. Descriptive statistics were performed. Palliative opportunities were evaluated over temporal quartiles from diagnosis to death. Timing and rationale of pediatric PC consultation were evaluated.
Patients (n = 92) had a median of 5.0 (interquartile range [IQR] 6.0) palliative opportunities, incurring 522 total opportunities, increasing toward the EOL. Number and type of opportunities did not differ by demographics. PC consultation was most common in patients with lymphoid leukemia (50.9%, 28/55) and myeloid leukemia (48.5%, 16/33) versus lymphoma (0%, 0/4, p = 0.14). Forty-four of ninety-two patients (47.8%) received PC consultation a median of 1.8 months (IQR 4.1) prior to death. Receipt of PC was associated with transplant status (p = 0.0018) and a higher number of prior palliative opportunities (p = 0.0005); 70.3% (367/522) of palliative opportunities occurred without PC.
Patients with hematologic malignancies experience many opportunities warranting PC support. Identifying opportunities for ideal timing of PC involvement may benefit patients with hematologic cancers and their caregivers.
尽管预后良好，但患有血液系统恶性肿瘤的儿科患者仍面临重大挑战，这可能导致生活质量下降或家庭压力增大。他们接受专业姑息治疗（PC）咨询的可能性较小，且往往接受强化临终关怀。我们研究了“姑息治疗机会”，即在患者血液系统恶性肿瘤病程中，PC 最有可能产生重大影响的事件，以及相关关联。
对 2012 年 1 月 1 日至 2017 年 11 月 30 日期间在我院死亡的 0-18 岁血液系统恶性肿瘤患儿进行了一项单中心回顾性研究。收集了人口统计学、疾病和治疗数据。定义了九个姑息治疗机会类别。进行了描述性统计。根据诊断到死亡的时间四分位数评估姑息治疗机会。评估了儿科 PC 咨询的时机和理由。
患者（n=92）平均有 5.0 次（四分位距[IQR]6.0）姑息治疗机会，共发生 522 次机会，在接近生命终末期时逐渐增加。机会的数量和类型不因人口统计学特征而不同。PC 咨询最常见于淋巴细胞白血病（50.9%，28/55）和髓系白血病（48.5%，16/33）患者，而非淋巴瘤患者（0%，0/4，p=0.14）。92 例患者中有 44 例（47.8%）在死亡前中位数 1.8 个月（IQR 4.1）接受了 PC 咨询。接受 PC 治疗与移植状态（p=0.0018）和之前姑息治疗机会较多（p=0.0005）有关；522 次姑息治疗机会中有 70.3%（367/522）在没有 PC 的情况下发生。
患有血液系统恶性肿瘤的患者有许多机会需要 PC 支持。确定 PC 参与的理想时机的机会可能使血液系统恶性肿瘤患者及其护理人员受益。
