End-of-Life Symptoms Comparable in Haematological, Solid Cancer Patients

Haematological malignancy patients could benefit from greater access to palliative care services

medwireNews: The burden of end-of-life symptoms and physical decline is similar in haematological and solid malignancy patients, suggests research published in The Lancet Haematology.

“This finding questions present limited palliative care service use by patients with haematological malignancies”, say David Currow, from Flinders University in Adelaide, South Australia, Australia and co-authors.

In all, 224 patient with a haematological malignancy, most commonly lymphoma, acute leukaemia and multiple myeloma, and 4414 patients with solid tumours, including lung, colon and breast cancer, were assessed between 7 and 90 days before death using the Symptom Assessment Scale for insomnia, loss of appetite, nausea, bowel and breathing problems, fatigue, pain, and vomiting.

Haematological malignancy patients were referred for palliative care at a significantly later point than their solid tumour counterparts, at a median of 34 and 56 days before death, respectively.

Among patients with haematological malignancies, fatigue had the highest average symptom burden, at 5.2 points on a 10-point scale, where zero equals no distress and 10 equals worst distress.

Loss of appetite was the second most common issue, with an average score of 2.3, and both fatigue and appetite symptoms became increasingly more distressing over time, as did the total burden of symptom distress.

By contrast, other symptoms were stable over the study period and were more often absent than present.

For solid tumour patients, fatigue, pain and loss of appetite were the most common symptoms but there was no significant difference between the severity of their symptoms and those of the haematological patients.

Moreover, the change in physical function, as measured using the Australia-modified Karnofsky performance scale, was “almost identical” between the two patient groups, with a “moderate” but significant decrease between 60 and 30 days before death, followed by a significant “steeper” decline between 30 and 7 days.

While their study was conducted in a large regional community palliative care provider in Australia, the “findings probably match the patterns of haematological cancer care seen in other resource-rich countries”, David Currow et al write.

They conclude: “This finding has practical implications for how individual clinicians and health systems overall identify and respond to these symptoms.”

Simon Noble, from Cardiff University in the UK, agrees in a comment that the “striking” findings provide “an opportunity to improve advanced care planning and to enable patients to be in their preferred place of care at the end of life.”

Noting that the benefits of “early and concurrent” palliative care are clear in patients with solid tumours, he suggests this model could be applied to those with haematological malignancies.

Simon Noble writes: “Even acknowledging that some patients might need ongoing support with blood products or parenteral antibiotics, these cases are the exception and not the norm.”

“Furthermore, such interventions provide excellent palliation for patients and could be considered as triggers to prompt discussions about end-of-life decisions rather than becoming a reason to prolong hospital stay.”

References

LeBlanc TW, Smith JM, Currow DC. Symptom burden of haematological malignancies as death approaches in a community palliative care service: a retrospective cohort study of a consecutive case series. Lancet Haematol 2015; Advance online publication 27 July. DOI: dx.doi.org/10.1016/S2352-3026(15)00111-8

Noble S. Palliation for haematological and solid tumours: what difference? Lancet Haematol 2015; Advance online publication 27 July. DOI: dx.doi.org/10.1016/S2352-3026(15)00128-3

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