Alemu Helen, Pope Ashley, Lo Samantha, Chin-Yee Nicolas, Khorramak Katayoun, Cenizal Criselda Isabel, Le Lisa W, Caruso Dior, Chen Christine, Kuruvilla John, Zimmermann Camilla, Hannon Breffni
Department of Supportive Care (H.A., A.P., S.L., N.C.Y., K.K., C.I.C., C.Z., B.H.), Princess Margaret Cancer Center, Toronto, Canada.
Department of Biostatistics (L.W.L.), University Health Network, Toronto, Canada.
J Pain Symptom Manage. 2025 Apr;69(4):420-427.e2. doi: 10.1016/j.jpainsymman.2025.01.005. Epub 2025 Jan 17.
Hematological malignancies represent a heterogeneous group of diseases with variable and often unpredictable illness trajectories. Comparisons between hematological and solid tumor malignancy referrals to an outpatient palliative care clinic have not been explored.
This study compared characteristics, referral trends, and time from first palliative care clinic visit to death between patients with hematological and solid tumor malignancies.
A retrospective review of palliative care clinic referrals at a tertiary cancer center from January 1st, 2018 to December 31st, 2022 was conducted. Clinical and demographic data, symptom burden, performance status, and time from first palliative care clinic visit to death were compared.
Of 5230 outpatients, 283 (5.4%) had a hematological malignancy (107 [38%] leukemia, 98 [35%] lymphoma, and 78 [28%] multiple myeloma). Patients with leukemia and lymphoma had similar symptom burden to solid tumor malignancies; patients with multiple myeloma had significantly more pain (P < 0.0001) and constipation (P = 0.005). Patients with hematological malignancies had worse performance status compared with solid tumor malignancies (ECOG ≥3 for 37.9% leukemia, 35.0% lymphoma, and 31.6% multiple myeloma vs. 19.6% solid tumor malignancies, P < 0.0001). At 12-months from first palliative care clinic visit, survival probabilities were 27.6% for leukemia, 42.2% lymphoma, and 69.5% multiple myeloma vs. 39.5% solid tumor malignancies.
Patients with hematological malignancies experience at least similar symptom burden to those with solid tumor malignancies referred to a palliative care clinic, and worse performance status, factors that should be considered when designing palliative care clinic interventions for patients with hematological malignancies.
血液系统恶性肿瘤是一组异质性疾病，疾病轨迹多变且往往不可预测。血液系统恶性肿瘤和实体肿瘤转诊至门诊姑息治疗诊所的情况尚未得到研究。
本研究比较了血液系统恶性肿瘤和实体肿瘤患者的特征、转诊趋势以及从首次姑息治疗诊所就诊到死亡的时间。
对2018年1月1日至2022年12月31日在一家三级癌症中心的姑息治疗诊所转诊病例进行回顾性研究。比较了临床和人口统计学数据、症状负担、体能状态以及从首次姑息治疗诊所就诊到死亡的时间。
在5230名门诊患者中，283名（5.4%）患有血液系统恶性肿瘤（107名[38%]白血病，98名[35%]淋巴瘤，78名[28%]多发性骨髓瘤）。白血病和淋巴瘤患者的症状负担与实体肿瘤恶性肿瘤患者相似；多发性骨髓瘤患者的疼痛（P<0.0001）和便秘（P=0.005）明显更多。与实体肿瘤恶性肿瘤患者相比，血液系统恶性肿瘤患者的体能状态更差（37.9%的白血病患者、35.0%的淋巴瘤患者和31.6%的多发性骨髓瘤患者ECOG≥3，而实体肿瘤恶性肿瘤患者为19.6%，P<0.0001）。从首次姑息治疗诊所就诊起12个月时，白血病患者的生存概率为27.6%，淋巴瘤患者为42.2%，多发性骨髓瘤患者为69.5%，而实体肿瘤恶性肿瘤患者为39.5%。
血液系统恶性肿瘤患者的症状负担至少与转诊至姑息治疗诊所的实体肿瘤恶性肿瘤患者相似，且体能状态更差，这些因素在为血液系统恶性肿瘤患者设计姑息治疗诊所干预措施时应予以考虑。
