Effect of Speciallist Palliative Care Service on End-of Life Care in Patients with Hematologic Malignancies

• Published in: Blood 2018-11, Vol.132 (Supplement 1), p.2242-2242
• Main Authors: Kihara, Rika, Ishiguri, Yumi, Ueda, Norihiro, Asai, Yasuyuki, Odagiri, Takuya, Watamoto, Koichi, Watanabe, Hiroaki
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2018-99-110127

Previous research demonstrated that patients with hematologic malignancies have a high probability receiving intensive care at their end-of-life (EOL). In this study, we assessed EOL quality measures in patients with hematologic malignancies before and after starting the provision of a specialist palliative care service. We conducted a retrospective cohort study in Komaki City Hospital. Provision of the specialist palliative care service was started in our hospital on April 1, 2012. We reviewed the medical records of all adult patients who died of hematologic malignancies between April 1, 2007 and March 31, 2017. Patients who had been cared for in the Departments of Hematology and Palliative Care were included. This study was approved by the institutional review board of Komaki City Hospital. We assessed the prevalence and trends of multiple measures of intensive EOL care established in the peer-reviewed literature. Intensive EOL care was defined as the occurrence of at least one of the following acts: 1) cardiopulmonary resuscitation (CPR) in the last 30 days of life, 2) intubation in the last 30 days of life, 3) intensive care unit (ICU) admission in the last 30 days of life, 4) chemotherapy use within the last 14 days of life, 5) receiving red cell transfusions within the 7 days before death, and 6) receiving platelet transfusion within the 7 days before death. Analysis of frequencies was performed using Fisher's exact test for 2 x 2 tables. The Cochran-Armitage test was used to test for trends over time. A total of 351 consecutive patients who died from hematologic malignancies were identified: 176 before and 175 after April 1, 2012. The median age at death was 73 years old. These included 150 patients with non-Hodgkin lymphoma, 113 with acute myeloid leukemia, 63 with multiple myeloma, 11 with acute lymphoblastic leukemia, 8 with chronic lymphocytic leukemia, and 5 with Hodgkin lymphoma. A total of 69 (39%) received specialist palliative care consultation and 24 (14%) died in the palliative care unit (PCU) after April 2012. Deaths in the PCU increased from 1 (2%) in 2012 to 8 (27%) in 2016 (P for trend