Palliative care in hematologic malignancies: a multidisciplinary approach

ABSTRACT

Introduction: Palliative care is specialized health care focused on improving the quality of life amid serious illness. Patients with hematologic malignancies have significant needs that could be addressed by a multidisciplinary palliative care team, but the integration of palliative care into hematology is far behind that of solid tumor oncology.

Areas covered: This article considers what is known about the palliative care needs of hematologic malignancy patients, shows how the multidisciplinary palliative care team could improve their care, and explores how barriers to this relationship might be overcome. The evidence to support this review comes from review of recent, relevant papers known to the authors as well as PubMed searches of additional relevant articles over the past 3 years.

Expert opinion: Further cultivating this relationship requires us to thoughtfully integrate the multidisciplinary palliative care team to respond to each patient’s specific disease and needs, and do so at the ideal time, to maximize benefits.

KEYWORDS:

• Hematologic malignancies
• palliative care
• review article
• multidisciplinary care
• interdisciplinary team

Article highlights box

• Palliative care is a specialized health care for patients with serious illness that focuses on improving quality of life; this holistic care is best practiced by a team of physicians, advanced practice nurses, physician assistants, nurses, social workers, and chaplains.

• While palliative care interventions in oncology have shown improved symptom management and QOL, the literature on palliative care in hematologic malignancies is far behind the literature in solid tumor oncology.

• Hematologic malignancy patients report poor QOL, with high burden of both physical and psychological symptoms.

• Multidisciplinary palliative care teams are uniquely equipped to respond to these needs in hematologic malignancy patients, but are largely untested.

• Factors intrinsic to hematologic oncology, as well as both patient and oncologists' perceptions, act as barriers to integrated palliative care; these include lack of predictable disease course with an overall focus on cure, clinician ownership over patients and a misperception of palliative care as only focused on death and dying.

• One RCT used hospitalization for stem-cell transplantation as a trigger for palliative care consultation, and demonstrated improvement in patients’ QOL and mood 2 weeks after the transplant, as well as sustained improvements in mood 6 months after the transplant, and benefits in caregiver mood.

• We should continue to work toward appropriately timed palliative care consultation, which may initially involve trying different prognosis-independent triggers for consultation.

• The unique needs of different hematologic malignancies require further study, particularly regarding how palliative care might serve these differing patient populations optimally.

• Education of hematologic oncologists and palliative care clinicians must be bi-directional in order for patients to maximally benefit; by better understanding each other’s perspectives, we can collaborate more effectively.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.