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Symptom burden of haematological malignancies as death approaches in a community palliative care service: a retrospective cohort study of a consecutive case series.

Publication ,  Journal Article
LeBlanc, TW; Smith, JM; Currow, DC
Published in: Lancet Haematol
August 2015

BACKGROUND: Patients with haematological malignancies are less likely to use palliative care services than are patients with solid tumours. This difference might stem from differing symptom burden, care needs, disease trajectories, or a combination of these factors. We described symptom burden and physical decline over time for people with haematological malignancies compared with people with solid tumours in a consecutive case series. METHODS: We included patients admitted to Silver Chain Hospice Care Service who died between Jan 1, 2011, and Dec 31, 2013, and who completed the eight-item Symptom Assessment Scale (0-10, with 0=no distress and 10=worst distress) at each clinical encounter. Physical function was assessed with the Australia-modified Karnofsky performance scale. Symptom and functional assessments were analysed at 7 days, 30 days, 60 days, and 90 days before death, by descriptive statistics. FINDINGS: We included 4638 participants. For people with haematological malignancies (n=224), the most troublesome symptoms were fatigue (mean score 5·2, SD 2·7) and loss of appetite (2·3, SD 2·9), and both worsened significantly near death (p=0·0035 for fatigue, p=0·016 for appetite). Other symptoms were often absent, and changed little over time. Compared with patients with solid tumours (n=4414), there were no significant differences in individual or cumulative symptom scores, changes over time, or the pattern of functional decline. INTERPRETATION: Community patients with haematological malignancies receiving palliative care have similar symptoms and patterns of physical decline at the end of life to people with solid tumours, suggesting similar care needs. This finding questions present limited palliative care service use by patients with haematological malignancies. FUNDING: None.

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Published In

Lancet Haematol

DOI

EISSN

2352-3026

Publication Date

August 2015

Volume

2

Issue

8

Start / End Page

e334 / e338

Location

England

Related Subject Headings

  • Retrospective Studies
  • Palliative Care
  • Middle Aged
  • Male
  • Humans
  • Hospice Care
  • Hematologic Neoplasms
  • Female
  • Cost of Illness
  • Aged, 80 and over
 

Citation

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LeBlanc, T. W., Smith, J. M., & Currow, D. C. (2015). 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, 2(8), e334–e338. https://doi.org/10.1016/S2352-3026(15)00111-8
LeBlanc, Thomas W., Joanna M. Smith, and David C. Currow. “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 2, no. 8 (August 2015): e334–38. https://doi.org/10.1016/S2352-3026(15)00111-8.
LeBlanc, Thomas W., et al. “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, vol. 2, no. 8, Aug. 2015, pp. e334–38. Pubmed, doi:10.1016/S2352-3026(15)00111-8.
Journal cover image

Published In

Lancet Haematol

DOI

EISSN

2352-3026

Publication Date

August 2015

Volume

2

Issue

8

Start / End Page

e334 / e338

Location

England

Related Subject Headings

  • Retrospective Studies
  • Palliative Care
  • Middle Aged
  • Male
  • Humans
  • Hospice Care
  • Hematologic Neoplasms
  • Female
  • Cost of Illness
  • Aged, 80 and over