Hematology Unit and Chair, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.
Statistic Unit, Department of Medical and Surgical Sciences, UNIMORE, Modena, Italy.
BMJ Support Palliat Care. 2024 Aug 19;14(3):291-294. doi: 10.1136/spcare-2023-004524.
Although early palliative care (EPC) is beneficial in acute myeloid leukaemia, little is known about EPC value in multiple myeloma (MM). We compared quality indicators for palliative and end-of-life (EOL) care in patients with MM receiving EPC with those of patients who received usual haematological care (UHC).
This observational, retrospective study was based on 290 consecutive patients with MM. The following indicators were abstracted: providing psychological support, assessing/managing pain, discussing goals of care, promoting advance care plan, accessing home care services; no anti-MM treatment within 14 and 30 days and hospice length of stay >7 days before death; no cardiopulmonary resuscitation, no intubation, <2 hospitalisations and emergency department visits within 30 days before death. Comparisons were performed using unadjusted and confounder-adjusted regression models.
55 patients received EPC and 231 UHC. Compared with UHC patients, EPC patients had a significantly higher number of quality indicators of care (mean 2.62±1.25 vs 1.12±0.95; p<0.0001)); a significant reduction of pain intensity over time (p<0.01) and a trend towards reduced aggressiveness at EOL, with the same survival (5.3 vs 5.46 years; p=0.74)).
Our data support the value of integrating EPC into MM routine practice and lay the groundwork for future prospective comparative studies.
虽然早期姑息治疗（EPC）对急性髓系白血病有益，但对于多发性骨髓瘤（MM）中 EPC 的价值知之甚少。我们比较了接受 EPC 的 MM 患者与接受常规血液学护理（UHC）的患者的姑息治疗和终末期（EOL）护理质量指标。
这是一项观察性、回顾性研究，基于 290 例连续 MM 患者。提取以下指标：提供心理支持、评估/管理疼痛、讨论护理目标、促进预先护理计划、获得家庭护理服务；在死亡前 14 天和 30 天内没有抗-MM 治疗，临终关怀时间>7 天；在死亡前 30 天内没有心肺复苏、没有插管、<2 次住院和急诊就诊。使用未调整和混杂因素调整的回归模型进行比较。
55 例患者接受 EPC，231 例患者接受 UHC。与 UHC 患者相比，EPC 患者的护理质量指标明显更高（平均 2.62±1.25 与 1.12±0.95；p<0.0001））；疼痛强度随时间的显著降低（p<0.01）和 EOL 侵袭性的趋势降低，具有相同的生存（5.3 与 5.46 年；p=0.74））。
我们的数据支持将 EPC 纳入 MM 常规实践的价值，并为未来的前瞻性比较研究奠定了基础。
