Patients with hematologic malignancies face many unmet palliative and supportive care needs. These include, but are not limited to, a sizeable symptom burden, impaired quality of life, significant psychological distress, difficult decisional scenarios, and uncertainty about prognosis. Yet compared to patients with solid tumors, those with hematologic malignances are much less likely to receive specialist palliative care services, despite having similar or greater palliative care needs than those with advanced solid tumors. Patients with hematologic malignancies are also more likely to receive aggressive care at the end of life, including more frequent us of chemotherapy in the last 14 days of life, more frequent hospitalizations and emergency department use in the last month of life, more use of intensive care services in the last month of life, a lower likelihood of using hospice care services at all, and a higher likelihood of dying in the hospital. These markers of poor-quality care at the end of life, coupled with the recognition of unmet palliative and supportive care needs upstream from the end of life in the hematology population, have led to increased interest in efforts to integrate specialist palliative care services into the management of patients with hematologic malignancies. As a dual-trained oncologist and palliative care physician, whose clinical practice focuses on the care of patients with hematologic malignancies, I will focus this lecture on 3 important areas: (1) demonstration of the unmet palliative care needs in hematology patients, (2) description of differences in hematologic diseases that call for a unique approach to integrating palliative care services in this population, and (3) highlighting examples of successful integration in this population, even alongside curative treatment, along with future opportunities to collaborate more closely with hematologists to improve the lives of patients and families who face a blood cancer diagnosis.
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