Department of Clinical Haematology, Monash Health, Clayton, Victoria, Australia.
Department of Supportive and Palliative Care, Monash Health, Clayton, Victoria, Australia.
J Natl Compr Canc Netw. 2023 Aug;21(8):813-820.e1. doi: 10.6004/jnccn.2023.7033.
Early palliative care is increasingly used in solid organ malignancy but is less established in patients with hematologic malignancy. Disease-related factors increase the demand for hospitalization, treatment, and supportive care in patients with hematologic malignancy. The terminal phase of illness in patients with hematologic malignancy can be difficult to predict, resulting in complexities in establishing a standard for quality end-of-life care.
This is a retrospective single-center cohort study of adult patients with hematologic malignancy who died between October 2019 and July 2022. Patients were identified, and disease characteristics, therapy, and outcomes were extracted from medical records. Descriptive statistics are reported and univariate analyses were performed across a range of factors to assess for associations.
A total of 229 patients were identified, with a median age of 77 years and 35% female. In the final 30 days of life, 65% presented to the emergency department, 22% had an ICU admission, 22% had an invasive procedure, 48% received cytotoxic therapy, 61% received a RBC transfusion, and 46% received a platelet transfusion. Use of intensive chemotherapy was particularly associated with hospitalization and ICU admission. A total of 74% referred to palliative care, with a median time from referral to death of 13 days. Of these patients, one-third were referred within the last 5 days of life. In terms of place of death, 54% died in the acute hospital setting and 30% in hospice, with a median hospice length of stay of 4 days.
These findings highlight the need for further research into quality indicators for end of life in hematologic malignancy and earlier integration of specialist supportive and palliative care in both inpatient and outpatient settings.
早期姑息治疗在实体器官恶性肿瘤中越来越多地使用，但在血液恶性肿瘤患者中应用较少。疾病相关因素增加了血液恶性肿瘤患者住院、治疗和支持性护理的需求。血液恶性肿瘤患者疾病终末期难以预测，导致难以确定高质量临终关怀的标准。
这是一项回顾性单中心队列研究，纳入 2019 年 10 月至 2022 年 7 月期间死亡的成年血液恶性肿瘤患者。从病历中提取患者的疾病特征、治疗和结局等数据。报告描述性统计数据，并对一系列因素进行单变量分析，以评估关联。
共纳入 229 例患者，中位年龄为 77 岁，35%为女性。在生命的最后 30 天，65%的患者到急诊就诊，22%的患者入住 ICU，22%的患者接受了有创操作，48%的患者接受了细胞毒性治疗，61%的患者接受了红细胞输血，46%的患者接受了血小板输血。强化化疗的使用与住院和 ICU 入院尤其相关。共有 74%的患者接受了姑息治疗，从转介到死亡的中位时间为 13 天。这些患者中有三分之一是在生命的最后 5 天内转介的。在死亡地点方面，54%的患者在急性医院环境中死亡，30%的患者在临终关怀机构中死亡，临终关怀机构的中位停留时间为 4 天。
这些发现强调了需要进一步研究血液恶性肿瘤患者临终关怀的质量指标，并在住院和门诊环境中更早地整合专科支持性和姑息治疗。
