Myeloma Patients Most Likely to Be Referred to Palliative Care Specialist

Results of a new study indicate that the integration between hematology and specialist palliative care services might be greater than previously thought when it comes to patients with hematologic malignancies. In the study, about half of patients with acute myeloid leukemia, diffuse large B-cell lymphoma, or myeloma were referred to specialist palliative care, with the highest rates of referral among those with myeloma. 

According to background information in the study, published in BMJ: Supportive & Palliative Care, patients with hematologic malignancies are reported to be less likely than other patients with cancer to be referred to a palliative care specialist or hospice services. The transition to palliative care is particularly complicated in patients with these diseases because treatment can be given with curative intent, life-prolonging intent, or for symptom control, depending on the type of malignancy.

“These diseases are associated with uncertainty about when specialist palliative care referrals should be made and they have significantly shorter intervals between referral and death compared to other cancers,” wrote Debra A. Howell, MD, of the Epidemiology and Cancer Statistics Group at the University of York, North Yorkshire, United Kingdom, and colleagues. “Patients with hematological malignancies are also more likely to die in hospital, a finding that is consistent across the disease spectrum despite the very diverse individual diagnostic subtypes.”

Therefore, with this study Howell and colleagues wanted to capture information on care pathways and transition of patients with these hematologic malignancies from time of diagnosis to death. They looked at a UK cohort of 323 patients who had been diagnosed with acute myeloid leukemia (33.1%), diffuse large B-cell lymphoma (31.6%), or myeloma (35.3%) between May 2005 and April 2008 and died before April 2010.

Results indicated that 47.9% of patients had at least one referral to a palliative care specialist. No difference in referrals patterns emerged for patient age or sex.

Patients with myeloma were almost twice as likely to be referred to a specialist (OR = 1.96; 95% CI, 1.15-3.35) compared with patients with acute myeloid leukemia.

“By contrast with some of the other hematological malignancies, myeloma has many potential complications at diagnosis and relapse, including bone disease and fractures, severe and complex pain and renal failure,” the researchers wrote. “These problems often require support from a multidisciplinary team of clinicians in these areas. Specialist palliative care practitioners are widely recognized and acknowledged for their skills in the management of complex issues such as these.”

Additionally, those patients who survived more than 1 year from diagnosis were six times more likely to be referred (OR = 6.58; 95% CI, 3.32-13.03) than those patients who died within 1 month of diagnosis.

Finally, results indicated that patients who died at home were three times more likely to have received a palliative care referral (OR = 3.07; 1.59-5.93) and those dying in hospice were about five times more likely to have received a referral (OR = 4.74; 95% CI, 1.51-14.81) than patients who died in the hospital.

“Increased integration between clinical hematologists and palliative care specialists may improve end-of-life planning for patients and, particularly, the facilitation of home death when this is the preferred place, even if the disease trajectory mitigates against this for many,” the researchers concluded.