Potenza Leonardo, Scaravaglio Miki, Fortuna Daniela, Giusti Davide, Colaci Elisabetta, Pioli Valeria, Morselli Monica, Forghieri Fabio, Bettelli Francesca, Messerotti Andrea, Catellani Hillary, Gilioli Andrea, Marasca Roberto, Borelli Eleonora, Bigi Sarah, Longo Giuseppe, Banchelli Federico, D'Amico Roberto, L Back Anthony, Efficace Fabio, Bruera Eduardo, Luppi Mario, Bandieri Elena
Hematology Unit and Chair, Azienda Ospedaliera Universitaria Policlinico and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
Hematology Unit and Chair, Azienda Ospedaliera Universitaria Policlinico and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.
BMJ Support Palliat Care. 2021 Nov 8. doi: 10.1136/bmjspcare-2021-002898.
Early palliative supportive care has been associated with many advantages in patients with advanced cancer. However, this model is underutilised in patients with haematological malignancies. We investigated the presence and described the frequency of quality indicators for palliative care and end-of-life care in a cohort of patients with acute myeloid leukaemia receiving early palliative supportive care.
This is an observational, retrospective study based on 215 patients consecutively enrolled at a haematology early palliative supportive care clinic in Modena, Italy. Comprehensive hospital chart reviews were performed to abstract the presence of well-established quality indicators for palliative care and for aggressiveness of care near the end of life.
131 patients received a full early palliative supportive care intervention. All patients had at least one and 67 (51%) patients had four or more quality indicators for palliative care. Only 2.7% of them received chemotherapy in the last 14 days of life. None underwent intubation or cardiopulmonary resuscitation and was admitted to intensive care unit during the last month of life. Only 4% had either multiple hospitalisations or two or more emergency department access. Approximately half of them died at home or in a hospice. More than 40% did not receive transfusions within 7 days of death. The remaining 84 patients, considered late referrals to palliative care, demonstrated sensibly lower frequencies of the same indicators.
Patients with acute myeloid leukaemia receiving early palliative supportive care demonstrated high frequency of quality indicators for palliative care and low rates of treatment aggressiveness at the end of life.
早期姑息支持治疗已被证明对晚期癌症患者有诸多益处。然而，这种模式在血液系统恶性肿瘤患者中未得到充分利用。我们调查了一组接受早期姑息支持治疗的急性髓系白血病患者中姑息治疗和临终关怀质量指标的存在情况，并描述了其频率。
这是一项基于意大利摩德纳一家血液科早期姑息支持治疗诊所连续纳入的215例患者的观察性回顾性研究。通过全面查阅医院病历，提取已确立的姑息治疗质量指标以及临终时积极治疗的指标。
131例患者接受了完整的早期姑息支持治疗干预。所有患者至少有一项姑息治疗质量指标，67例（51%）患者有四项或更多姑息治疗质量指标。仅2.7%的患者在生命的最后14天接受了化疗。在生命的最后一个月，无人接受插管或心肺复苏，也无人入住重症监护病房。只有4%的患者有多次住院或两次或更多次前往急诊科就诊的情况。约一半患者在家中或临终关怀机构死亡。超过40%的患者在死亡前7天内未接受输血。其余84例患者被视为晚期接受姑息治疗，其相同指标的频率明显较低。
接受早期姑息支持治疗的急性髓系白血病患者表现出较高的姑息治疗质量指标频率和较低的临终治疗积极性。
