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Retrospective review of end-of-life care in the last month of life in older patients with multiple myeloma: what collaboration between haematologists and palliative care teams?
  1. Thomas Chalopin1,
  2. Nicolas Vallet1,
  3. Lotfi Benboubker1,
  4. Marlène Ochmann2,
  5. Emmanuel Gyan1,3 and
  6. François Chaumier4,5
  1. 1Department of Haematology and Cell Therapy, Regional University Hospital Centre Tours, Tours, Centre-Val de Loire, France
  2. 2Department of Haematology, Regional Hospital Centre Orleans, Orleans, Centre-Val de Loire, France
  3. 3CNRS ERL 7001 LNOx (Leukemic Niche & redOx metabolism), Université de Tours, Tours, Centre-Val de Loire, France
  4. 4Palliative Care Team, Regional University Hospital Centre Tours, Tours, Centre-Val de Loire, France
  5. 5UMR INSERM U1246 SPHERE (methodS in Patients-centered outcomes and HEalth ResEarch), Université de Tours, Tours, Centre-Val de Loire, France
  1. Correspondence to Dr François Chaumier, Palliative Care Team, Regional University Hospital Centre Tours, 37000 Tours, France; francois.chaumier{at}univ-tours.fr

Abstract

Objectives Patients with haematological malignancies (HM) receive more aggressive treatments near the end-of-life (EOL) than patients with solid tumours. Palliative care (PC) needs are less widely acknowledged in patients with multiple myeloma (MM) than in other HM. The main objective of our study was to describe EOL care and PC referral in a population of older patients with MM.

Methods We retrospectively included deceased inpatients and outpatients with an MM previously diagnosed at the age of 70 and over in two tertiary centres in France. We reported EOL characteristics regarding treatments considered to be aggressive—antimyeloma therapies, hospitalisations, blood product transfusions, intensive care units (ICUs) or emergency admissions—and PC referral.

Results We included 119 patients. In their last month of life, 75 (63%) were hospitalised for fever, pain, asthenia, anaemia or bleeding, 49 (41%) were admitted in the emergency department and 12 (10%) in ICU, 76 (64%) still received antimyeloma therapy and 45 (38%) had at least two transfusions. Only 24 (20%) received PC intervention for pain, global care, family support, anxiety, social care or confusion. Median follow-up until death was 20 days.

Conclusions Our study found a high rate of hospitalisations and antimyeloma therapies in the last month of life. The PC referral rate was low, often once specific treatments were stopped. Our results suggest the need for more effective collaboration between PC teams and haematologists in order to respond to the specific needs of these patients and to improve their quality of care at EOL.

  • end of life care
  • haematological disease
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Footnotes

  • Contributors TC built the research, analysed data and wrote the article. NV analysed data and partially wrote the article. LB included patients in the research. MO included patients in the research. EG built the research and partially wrote the article. FC built the research, analysed data, partially wrote the article and was responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the local Human Research Ethics Committee (number 2019-022).

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

  • Data availability statement All data relevant to the study are included in the article

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