Contributions
Abstract: PB2392
Type: Publication Only
Background
Most Palliative Care (PC) patients have oncologic disease, being liquid tumors a part of it (around 7%). According to the literature, the latter should be individualized from solid tumors: they usually have more advanced stages of disease at diagnosis, more symptomatology expressed along their course and there is a shorter interval between the last treatment and the referral date or even death. There are few PC units in Europe with significant number of Onco-hematology (OH) patients admitted and characterized.
Aims
Review of all OH patients referred to the PC Service of one oncologic institution along four years, to understand their profile, the invasive medical decisions prescribed in their last month of life and how PC referral and care could be improved.
Methods
Clinical records of all OH patients referred to PC between 2014 and 2017 were reviewed and characterized (demography and disease, treatments, relevant medical decisions taken in the last month of life by PC and survival).
Results
A sample of 179 patients was reviewed and characterized: 94 males (52.5%), median age of 71 years [19-99]; 48.6% had Non-Hodgkin Lymphoma, 26.3% had Multiple Myeloma, 10.6% had Acute leukemia, 14.5% had other OH diseases. For those who were treated for their OH disease (n=158, median number of 2 lines [1-8]), 96.2% underwent chemotherapy, 28.5% radiotherapy and 21.5% underwent hematopoietic stem cell transplant. The referral was heterogeneous among physicians (27.4% from one physician). Most patients were observed first inpatient (55.3%), 17.9% in PC outpatient consult, 1.7% refused PC, 1.1% were transferred to another unit, one had home care and 23.5% died before being observed. At the end of this study, 98.3% died (89.2% in the hospital, 10.8% outside the hospital). The median time between the end of treatment and referral do PC was 45 days and between referral and death was 17 days. Medical prescription of PC patients in the last month of life was reviewed in the 176 patients who died: 39 patients were blood transfused (22 erythrocyte units and 17 platelets concentrates), 7 were prescribed with antibiotics and 3 with antifungal agents, 3 did a Computerized Tomography, 2 went through thoracentesis, 2 did PC radiotherapy, 2 were intervened surgically in the operation room; some procedures were done only once in the population studied, as echography, paracentesis, central venous catheterization, cystostomy and catheter positioning, hemodialysis, parenteral nutrition, nasogastric tube placed, Percutaneous Endoscopic Gastrostomy placement.
Conclusion
OH patients should be referred earlier to PC in order to better benefit from this planned and specialized care, preferentially followed in the out-patient consult. This decision requires a more integrative work between PC and OH physicians since diagnosis. In the last month of life a variety of invasive procedures were done, which should be minimized (for the lack of benefit and negative impact in patient’s quality of life).
Session topic: 36. Quality of life, palliative care, ethics and health economics
Keyword(s): Quality of Life
Abstract: PB2392
Type: Publication Only
Background
Most Palliative Care (PC) patients have oncologic disease, being liquid tumors a part of it (around 7%). According to the literature, the latter should be individualized from solid tumors: they usually have more advanced stages of disease at diagnosis, more symptomatology expressed along their course and there is a shorter interval between the last treatment and the referral date or even death. There are few PC units in Europe with significant number of Onco-hematology (OH) patients admitted and characterized.
Aims
Review of all OH patients referred to the PC Service of one oncologic institution along four years, to understand their profile, the invasive medical decisions prescribed in their last month of life and how PC referral and care could be improved.
Methods
Clinical records of all OH patients referred to PC between 2014 and 2017 were reviewed and characterized (demography and disease, treatments, relevant medical decisions taken in the last month of life by PC and survival).
Results
A sample of 179 patients was reviewed and characterized: 94 males (52.5%), median age of 71 years [19-99]; 48.6% had Non-Hodgkin Lymphoma, 26.3% had Multiple Myeloma, 10.6% had Acute leukemia, 14.5% had other OH diseases. For those who were treated for their OH disease (n=158, median number of 2 lines [1-8]), 96.2% underwent chemotherapy, 28.5% radiotherapy and 21.5% underwent hematopoietic stem cell transplant. The referral was heterogeneous among physicians (27.4% from one physician). Most patients were observed first inpatient (55.3%), 17.9% in PC outpatient consult, 1.7% refused PC, 1.1% were transferred to another unit, one had home care and 23.5% died before being observed. At the end of this study, 98.3% died (89.2% in the hospital, 10.8% outside the hospital). The median time between the end of treatment and referral do PC was 45 days and between referral and death was 17 days. Medical prescription of PC patients in the last month of life was reviewed in the 176 patients who died: 39 patients were blood transfused (22 erythrocyte units and 17 platelets concentrates), 7 were prescribed with antibiotics and 3 with antifungal agents, 3 did a Computerized Tomography, 2 went through thoracentesis, 2 did PC radiotherapy, 2 were intervened surgically in the operation room; some procedures were done only once in the population studied, as echography, paracentesis, central venous catheterization, cystostomy and catheter positioning, hemodialysis, parenteral nutrition, nasogastric tube placed, Percutaneous Endoscopic Gastrostomy placement.
Conclusion
OH patients should be referred earlier to PC in order to better benefit from this planned and specialized care, preferentially followed in the out-patient consult. This decision requires a more integrative work between PC and OH physicians since diagnosis. In the last month of life a variety of invasive procedures were done, which should be minimized (for the lack of benefit and negative impact in patient’s quality of life).
Session topic: 36. Quality of life, palliative care, ethics and health economics
Keyword(s): Quality of Life