Comparing the Palliative Care Needs of Patients With Hematologic and Solid Malignancies

被引:75
作者
Hochman, Michael J. [1 ]
Yu, Yinxi [2 ]
Wolf, Steven P. [2 ]
Samsa, Greg P. [2 ]
Kamal, Arif H. [1 ,3 ,4 ,5 ]
LeBlanc, Thomas W. [1 ,3 ,6 ]
机构
[1] Duke Univ, Sch Med, Durham, NC USA
[2] Duke Univ, Sch Med, Dept Biostat & Bioinformat, Duke Biostat Core, Durham, NC USA
[3] Duke Univ, Sch Med, Duke Canc Inst, Durham, NC USA
[4] Duke Univ, Sch Med, Dept Med, Div Med Oncol, Durham, NC 27706 USA
[5] Duke Univ, Duke Fuqua Sch Business, Durham, NC USA
[6] Duke Univ, Sch Med, Dept Med, Div Hematol Malignancies & Cellular Therapy, Durham, NC 27706 USA
基金
美国医疗保健研究与质量局; 美国国家卫生研究院;
关键词
Palliative care; hematologic malignancies; healthcare delivery; healthcare resources; QUALITY-OF-LIFE; RANDOMIZED CONTROLLED-TRIAL; STEM-CELL TRANSPLANTATION; CANCER-RELATED FATIGUE; SYMPTOM BURDEN; RETROSPECTIVE COHORT; FAMILY CAREGIVERS; CLINICAL-TRIAL; ACUTE-LEUKEMIA; HOSPICE CARE;
D O I
10.1016/j.jpainsymman.2017.08.030
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Context. Hematologic cancer patients use palliative care services less frequently than their solid tumor counterparts. Prior work suggests that these patients have a sizable symptom burden, but comparisons between hematologic and solid tumor patients near the end of life are limited. Objectives. To compare unmet symptom needs in a cohort of hematologic and solid tumor patients referred to specialty palliative care services. Methods. Using a novel data registry of initial palliative care encounters, we performed a cross-sectional analysis of cancer patients receiving care across 17 sites within the Global Palliative Care Quality Alliance. We compared clinically-significant symptoms (rated as four or greater in severity) between hematologic and solid tumor patients and performed multivariate logistic regression analyses examining the relationship between symptom burden and tumor type. Results. We identified 1235 cancer patients, 108 of which had hematologic malignancies. Pain, dyspnea, nausea, and anorexia burden were as high among patients with hematologic as those with solid malignancies. Blood cancer patients had higher rates of clinically-significant tiredness (51% vs. 42%; P = 0.03) than solid tumor patients. Finally, blood cancer patients had greater odds of being tired (odds ratio 2.19; CI 1.22-3.91) and drowsy (odds ratio 1.81; CI 1.07-3.07) than solid tumor patients independent of age, gender, race, and performance status. Conclusions. Hematologic and solid tumor patients have significant symptom burden at time of referral to palliative care services. Blood cancer patients may have unique concerns warranting targeted attention, including substantial drowsiness and tiredness. Our findings suggest a need to optimize palliative care usage in the hematologic cancer population. (C) 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
引用
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页码:82 / +
页数:8
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