Palliative care in onco-hematology: a perspective
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COMMENTARY
Palliative care in onco-hematology: a perspective Maria Eduarda Couto 1
&
José Ferraz-Gonçalves 2
Received: 11 June 2020 / Accepted: 16 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Palliative care (PC) is focused on individualized symptomatic control, psychological help, and support in the context of severe disease. Oncologic patients are still the most referred to PC and hematologic patients are only 7%. This is a commentary about PC applied to hematologic patients. There is evidence supporting that these patients behave as a special group in PC when compared with other tumors: there is a smaller number of referrals, with more advanced disease status, more symptomatology expressed, and less time between the last treatment date and the referral date or death. This article also expresses the experience of an oncologic palliative care unit. More health education programs in PC are needed for specialized professionals in hematology, as well as a change of nowadays health politics, in order to increase the participation of this specialized care in hematology. Keywords Hematology . Palliative care . Specialization
Onco-hematology and PC Palliative care (PC) is a multidisciplinary approach to symptom management, psychosocial and spiritual support, assistance in treatment decision-making for patients and families, medical home care, outpatient nursing and in challenging situations with prognostic uncertainty [1–3]. The UK was the first country in Europe to recognize PC as a medical specialty in 1987; in the USA, it became a medical sub-specialty in 2006 [2, 4]. Published results about PC are very supportive of its benefit, including economically [1–3, 5–7]. According to some specialized centers in PC, oncohematologic (OH) patients can be nearly 7% of all oncologic patients [8, 9]. They have substantial illness burden, undergo more aggressive therapies at the end of life (as chemotherapy, antibody therapies, CART cells, hematopoietic stem cell transplantation/HSCT), and experience high symptom burden This is a commentary about the particularities of treating oncohematologic patients in palliative care. * Maria Eduarda Couto [email protected] 1
Onco-hematology Service, Instituto Português de Oncologia do Porto Francisco Gentil E.P.E., Porto, Portugal
2
Palliative Care Service, Instituto Português de Oncologia do Porto Francisco Gentil E.P.E., Porto, Portugal
(fatigue for anemia, hemorrhagic events for thrombocytopenia, infectious events for neutropenia). OH patients typically have low hospice utilization but higher rates of hospitalization and hospitality deaths (some are admitted only to manage it) [2, 3, 10–14]. The authors did a retrospective study of about 179 OH patients in a PC service in Portugal. It was found a very short time between the end of treatment and referral to PC as well as between the referral time and death. Nearly 89% of the patients died in the hospital [8]. The authors also found that many invasive exams were made in the last month of
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