Palliative care in patients with haematological neoplasms: An integrative systematic review.

BACKGROUND: Palliative care was originally intended for patients with non-haematological neoplasms and relatively few studies have assessed palliative care in patients with haematological malignancies. AIM: To assess palliative care interventions in managing haematological malignancies patients treated by onco-haematology departments. DESIGN: Integrative systematic review with data extraction and narrative synthesis (PROSPERO #: CRD42016036240). DATA SOURCES: PubMed, CINAHL, Cochrane, Scopus and Web-of-Science were searched for articles published through 30 June 2015. Study inclusion criteria were as follows: (1) published in English or Spanish and (2) containing data on palliative care interventions in adults with haematological malignancies. RESULTS: The search yielded 418 articles; 99 met the inclusion criteria. Six themes were identified: (1) end-of-life care, (2) the relationship between onco-haematology and palliative care departments and referral characteristics, (3) clinical characteristics, (4) experience of patients/families, (5) home care and (6) other themes grouped together as 'miscellany'. Our findings indicate that palliative care is often limited to the end-of-life phase, with late referral to palliative care. The symptom burden in haematological malignancies patients is more than the burden in non-haematological neoplasms patients. Patients and families are generally satisfied with palliative care. Home care is seldom used. Tools to predict survival in this patient population are lacking. CONCLUSION: Despite a growing interest in palliative care for haematological malignancies patients, the evidence base needs to be strengthened to expand our knowledge about palliative care in this patient group. The results of this review support the need to develop closer cooperation and communication between the palliative care and onco-haematology departments to improve patient care.

Cuidados paliativos en hematología clínica: experiencia de una consulta integrativa en pacientes con mieloma múltiple / Palliative care in clinical haematology: Experience of an integrative outpatient clinic in patients with multiple myeloma

OBJETIVO: Describir la experiencia tras el primer año de funcionamiento de una consulta integrativa de cuidados paliativos en pacientes con mieloma múltiple. Materiales y MÉTODOS: Se revisaron las historias clínicas de los pacientes visitados por primera vez en la consulta de cuidados paliativos en pacientes con mieloma múltiple. Durante la primera y las 3 siguientes visitas se evaluaron: dolor, anorexia, estreñimiento, insomnio, náuseas y vómitos, disnea, ansiedad y tristeza; mediante una escala visual numérica [0-10]. Se calculó la carga sintomática de los síntomas físicos y emocionales mediante el sumatorio de las puntuaciones de sus escalas visuales numéricas. La intensidad del dolor y su interferencia se evaluó mediante la versión española del Brief Pain Inventory modificada ad hoc. RESULTADOS: De febrero a diciembre 2013, se visitaron 67 pacientes (mediana desde el diagnóstico 355 días), y tras 3 visitas de seguimiento (mediana 60 días) la proporción de pacientes con dolor moderado-severo (escala visual numérica≥5) se redujo para el «dolor máximo» (57 vs.18%; p < 0,0001) y el «dolor promedio» (24 vs.2%; p < 0,0001). La proporción de pacientes sin interferencia por el dolor mejoró: actividad general (52 vs.82%; p = 0,0001), sueño (73 vs.91%; p = 0,01), estado de ánimo (52 vs.87,5%; p = 0,0001). La carga sintomática física y emocional, y la proporción de pacientes deprimidos (13 vs.5%; p = 0,001) mejoraron. CONCLUSIONES: La integración de los cuidados paliativos en la atención de los pacientes con mieloma múltiple no solo es posible, sino que mejora de forma significativa los síntomas emocionales y físicos

AIM: To describe the experience after the first year of operation of an integrative palliative care clinic for patients with multiple myeloma. MATERIALS AND METHODS: The medical records were reviewed of patients seen for the first time in the integrative palliative care clinic for patients with multiple myeloma. During the first, and the next 3 visits, pain, anorexia, constipation, insomnia, nausea and vomiting, dyspnoea, anxiety, and sadness were evaluated using a visual numeric scale [0-10]. The symptomatic burden of physical and emotional symptoms was calculated by summing the scores of their visual numeric scale. The pain intensity and its interference were assessed using the Spanish version of the Brief Pain Inventory modified ad hoc. RESULTS: From February to December 2013, 67 patients (median 355 days from diagnosis) were seen, and after 3 follow up visits (median 60 days from the first visit) the proportion of patients with moderate-severe pain (visual numeric scale ≥ 5) was reduced for 'worst pain' (57% vs.18%; P < .0001) and 'average pain' (24% vs.2%; P < .0001). The proportion of patients without interference from pain improved in, general activity (52% vs.82%; P=.0001), sleep (73% vs.91%; P =.01), and mood (52% vs.87.5%; P = .0001). There was also improvement in the physical and emotional symptom burden, and the proportion of depressed patients (13% vs.5%; P = .001). CONCLUSIONS: The integration of palliative care in the care of patients with multiple myeloma is not only possible, but also significantly improves the emotional and physical symptoms

Is Early Palliative Care Feasible in Patients With Multiple Myeloma?

CONTEXT: Evidence for the benefits of early palliative care (EPC) in patients with solid tumors is strong, but EPC has received scant attention in hematologic malignancies. OBJECTIVE: To assess the benefits of outpatient-based EPC for symptom control in patients with multiple myeloma. METHODS: Retrospective study of patients attending the Multiple Myeloma Palliative Care Clinic at our hospital in the year 2013 (February 1-December 31). The following symptoms were assessed at baseline and at three follow-up consultations using a Numerical Visual Scale (0 = no symptoms; 10 = worst possible): pain, anorexia, constipation, insomnia, nausea/vomiting, dyspnea, anxiety, and sadness. Physical and emotional symptom burden scores were calculated. Pain interference with general activity, sleep, and mood was also evaluated. RESULTS: About 67 patients were included. The proportion of patients reporting moderate-to-severe pain (Numerical Visual Scale ≥5) decreased significantly from baseline to the final follow-up: worst pain decreased from 57% to 18% (P < 0.0001), whereas average pain fell from 24% to 2% (P < 0.0001). The percentage of patients reporting no pain interference increased significantly from baseline: general activity (52% vs. 82%; P = 0.0001), sleep (73% vs. 91%; P = 0.01), and mood (52% vs. 87.5%; P = 0.0001). Physical and emotional symptom burden also improved, with significantly fewer patients reporting depression (13% vs. 5%; P = 0.001). Most patients (86.6%) were alive and still attending the Multiple Myeloma Palliative Care Clinic at study end. CONCLUSIONS: These findings indicate that EPC is feasible in patients with multiple myeloma. Pain and other symptoms were well controlled.