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Hospital end-of-life care in haematological malignancies
  1. Yvan Beaussant1,2,
  2. Etienne Daguindau3,
  3. Adrien Chauchet3,
  4. Philippe Rochigneux4,
  5. Christophe Tournigand5,6,
  6. Régis Aubry1,2 and
  7. Lucas Morin7
  1. 1Department of Palliative Care, Besancon University Hospital, Besançon, France
  2. 2Inserm CIT808, Besancon University Hospital, Besancon, France
  3. 3Hematology Department, Besancon University Hospital, Besancon, France
  4. 4Department of Medical Oncology, Paoli-Calmettes Cancer Institute, Marseille, France
  5. 5Department of Medical Oncology, Hopital Henri Mondor, Assistance Publique—Hôpitaux de Paris, Créteil, France
  6. 6Paris-Est Creteil University, Créteil, France
  7. 7Aging Research Center, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Lucas Morin, Aging Research Center, Karolinska Institutet, Stockholm 113 30, Sweden; lucas.morin{at}ki.se

Abstract

Objective To investigate patterns of care during the last months of life of hospitalised patients who died from different haematological malignancies.

Methods Nationwide register-based study, including all hospitalised adults ≥20 years who died from haematological malignancies in France in 2010–2013. Outcomes included use of invasive cancer treatments and referral to palliative care. Percentages are adjusted for sex and age using direct standardisation.

Results Of 46 629 inpatients who died with haematological malignancies, 24.5% received chemotherapy during the last month before death, 48.5% received blood transfusion, 12.3% were under invasive ventilation and 18.1% died in intensive care units. We found important variations between haematological malignancies. The use of chemotherapy during the last month of life varied from 8.6% among patients with chronic myeloid leukaemia up to 30.1% among those with non-Hodgkin’s lymphoma (P<0.001). Invasive ventilation was used in 10.2% of patients with acute leukaemia but in 19.0% of patients with Hodgkin’s lymphoma (P<0.001). Palliative status was reported 30 days before death in only 14.8% of patients, and at time of death in 46.9% of cases. Overall, 5.5% of haematology patients died in palliative care units.

Conclusion A high proportion of patients who died from haematological malignancies receive specific treatments near the end of life. There is a need for a better and earlier integration of the palliative care approach in the standard practice of haematology. However, substantial variation according to the type of haematological malignancy suggests that the patients should not be considered as one homogeneous group. Implementation of palliative care should account for differences across haematological malignancies.

  • end-of-life care
  • hematologic neoplasms
  • intensive care
  • palliative care

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Footnotes

  • Contributors LM had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: LM, YB, AC, ED, PR. Acquisition of data: LM, RA, CT. Statistical analysis: LM. Interpretation of data: all authors. Drafting of manuscript or revision for important intellectual content: all authors.

  • Competing interests None declared.

  • Ethics approval This study was reviewed and approved by the French National Data protection Agency (CNIL, decision n°DE-2014–112) . In accordance with French regulation, additional ethical permit was not required because of the nature of the data collection (non-interventional study using irreversibly de-identified data related to deceased individuals).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Raw data cannot be made publicly available because of privacy issues. Additional tables can be provided by the authors on reasonable request.

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