Early Palliative Care in Hematologic Malignancies a Review of Current Knowledge

Mini Review

Ann Hematol Oncol. 2019; 6(8): 1263.

Early Palliative Care in Hematologic Malignancies a Review of Current Knowledge

Bounaix L1*, Guastella V2, Bay JO1, Bordessoule D3 and Moreau S3*

1Department of Hematology, University of Clermont- Ferrand, France

2Department of Palliative care, University of Clermont- Ferrand, France

3Department of Hematology, University of Limoges, France

*Corresponding author: Bounaix L, Department of Hematology, University of Clermont-Ferrand, 28 Place Henri Dunant, 63000 Clermont-Ferrand, France

Received: May 30, 2019; Accepted: July 11, 2019; Published: July 18, 2019

Abstract

Background: Hematology patients present a significant symptom burden and are more likely to receive aggressive care near the end of life. Palliative care in hematology is largely focused on end-of-life care, whereas it is increasingly recognized that the early integration of palliative care tends to improve quality of life in chronic disease.

Objectives: The goal of this review is to describe the barriers between early integration of palliative care and hematologic malignancies and discuss the potential contribution of early palliative care to hematology patients.

Methods: We conducted a narrative literature review by keywords in the Pubmed and Clinical Trials databases and with no time limitation. We also selected relevant articles in french papers and books on palliative care and hematology.

Results: Our review identified four main groups of symptoms of discomfort: physical, psychological, social, and medullary-related. We found a number of barriers hindering early integration of palliative care in hematology, chiefly the difficulty establishing prognosis, the clinical course features, and the clinicians themselves. A growing literature has shown that in other specialties such as oncology, cardiology or neurology, the early integration of palliative care has brought real benefit for quality of life and even overall survival. However, there is only a tiny handful of prospective studies currently ongoing to evaluate the benefit of palliative care integration in hematologic malignancies.

Conclusion: Early integration of palliative care tends to improve patient quality of life in other specialties, but the benefits have yet to be demonstrated in hematology.

Keywords: Quality of life, Hematological malignancies, Palliative and supportive care, Symptoms of discomfort

Abbreviations

EIPC: Early Integration of Palliative Care; QoL: Quality of Life; ASCO: American Society of Clinical Oncology; HM: Hematologic Malignancies; HP: Hematology Patients; PC: Palliative Care; EoLC: End-of-Life Care; HO: Hematologic Oncologists; PTSD: Post- Traumatic Stress Disorder

Introduction

A growing literature shows that Early Integration of Palliative Care (EIPC) in standard care brings real benefits to patients with life-limiting illnesses. EIPC leads to better Quality of Life (QoL) [1– 4] and mood [1], a decrease in pain and, to a larger extent, better management of discomfort symptoms [2,3]. Tailored management of these symptoms even improves the overall survival of patients with advanced cancer [1]. This data has prompted authorities such as the American Society of Clinical Oncology (ASCO) to issue recommendations on solid tumors that underline the importance of early management of discomfort symptoms [5,6]. Hematologic Malignancies (HM) are rare diseases yet still account for 10% of new cancer cases in France [7]. Hematology Patients (HP) present a high symptom burden early in the course of illness and are more likely to receive aggressive care near the end of life [8,9]. Palliative Care (PC) is increasingly being recommended early in solid tumor oncology and non-oncology diseases but remains largely focused on End-of-Life Care (EoLC) in HM. Even though solid tumors and HM are both cancers, their medical care patterns share a number of key differences, both in disease evolution and in patient and clinician profiles. Here we describe the barriers between EIPC and HM and discuss their potential contribution to HP.

The Barriers to Integration of Palliative Care in Hematologic Malignancies

HP are less likely to be referred for palliative care compared to solid cancers [8–16]. Several hypotheses have been put forward to explain this fact, most of which are drawn from observations of routine clinical practice. First, Hematologic Oncologists (HO) experience difficulty establishing a prognosis for HM and determining early when PC should begin [9,17], as clinical course is more uncertain with HM than solid tumors. Cancer patients present an initially slow pattern of decline that accelerates in the last months of life [18]. This “cancer trajectory” leaves the time needed to refer to the palliative team [19]. However, HP can either follow an “aggressive HM trajectory” marked by significant functional impairment at diagnosis that can be improved by treatment leading to a durable remission or else sudden unexpected dramatically lifethreatening complications like septic shock or uncontrolled bleeding causing death, or a “chronic HM trajectory” defined as a slow decline with intermittent life-threatening complications [12]. In both cases, patient prognosis is unpredictable [20] and triggers a sudden transition between curative care and PC. Furthermore, hematology is a medical specialty in which therapeutic innovations have been known to bring dramatic improvement [21]. These new target molecules bring a degree of optimism [22], but further complicate the task of establishing a prognosis and determining timely referral to PC when relapse occurs. Thus, in this context of advanced disease, patients, caregivers and doctors face an impossible dilemma between access to a new drug through a research protocol, and palliative care. In these situations, consideration as to the place of PC is very limited and comes too late. Patients and caregivers are caught up in a spiral of hard choices between inclusion in an early clinical trial and preparing for a peaceful end of life, between hope and distress, between ‘fighting’ disease or quiet rest. Second, there is both a lack of knowledge between the two specialties and acknowledgement between the two teams [23]. HO have misperceptions of PC. They see PC as EoLC or as “an alternative philosophy of care” [24] and take the stance that their cancer-related treatment goals are incompatible with PC. On the PC side, PC teams often underappreciate the uncertainty involved in hematological prognosis, as HP may respond to treatment even in advanced stages [13], and they tend to underestimate HP needs, such as the transfusions required until late in illness course, taking the stance that these therapies are futile and inappropriate. The difficulty organizing transfusions in hospice services may also be a barrier to referral for PC. Furthermore, there is no evidence in the literature on the benefit of EIPC in HM, which is not the case with solid tumors [8], and in this context a majority of HO wants to maintain care for all aspects of the disease, and thus prefer to provide PC themselves [25], whereas HP experience similar symptoms and physical decline patterns to solid-tumor patients in the last 3 months of life, which suggests they have similar EoLC needs [26,27]. The past few decades have seen HM become chronic diseases with long follow-up promoting tight relationship between HO and their HP. Third, the severity of the disease can require aggressive curative treatments like induction chemotherapy or hematopoietic stem cell transplantation that lead to a hugely uncomfortable life, with side effects that carry severe morbidity and risks of death. After such huge emotional investment to fight the disease together, the transition from curative intervention to PC may be especially difficult [28]. This maximal effort already invested by HP, caregivers and clinicians leads to an “escalation of commitment” where HO are tempted to suggest treatment with curative intent while the chances of response are known to be low [29]. This strong link may also explain why HO are reluctant to integrate other clinicians into patient care, which they feel would be disruptive [13,25] and a sign of failure in the relationship right at the toughest time. Furthermore, HO prefer to keep patients’ hopes up rather than talk about the poor prognosis or end-of-life issues [13], even though patients want to know clearly their prognosis is. Unfortunately, in particular cases such as stem cell transplantation, the patient’s understanding of prognosis is sometimes associated with poor QoL, increased depression and symptoms of discomfort [30], which may strengthen HO belief that it is better for HP to keep hold of a mistaken vision of their prognosis. Note too that some HO report being uncomfortable starting the conversion about end of-life issues, possibly due to this strong link with HP or to a lack of training on the requisite communication skills [31]. For all these reasons, the discussion about end-of-life issues occurs too late [14,32]. The pattern to date is that without early anticipation, a late sudden transition from curative to PC leaves little time for appropriate PC [10].

The Contribution of EIPC in Other Specialties

To date, several prospective trials of EIPC have been published in both oncology and non-oncology diseases such as heart failure. Despite different interventions and different methods, all confirm the absence of negative impact of EIPC. Several studies, particularly in oncology [1,3,4,33], have even shown a real benefit of EIPC, prompting authorities like ASCO to recommend bringing EIPC into standard oncology care [5,6]. The main benefits of EIPC are improved QoL, decreased discomfort symptoms and increased patient satisfaction [34]. Experience in solid tumor settings shows that EIPC does not alter the relationship between the solid tumor oncologists and patients. In fact PC is complementary to routine clinical care and both are valuable allies to assist solid tumor oncologists in managing symptoms or psychosocial distress [35]. Pain management seems to be different between solid tumors oncologists and PC staff. PC team appears to employ different pain management practices, with a noticeably higher use of opioids. EIPC reduces the risk of suffering from severe pain [36]. Successful management of discomfort symptoms and the external position of PC creates a climate of trust between palliative caregiver and patient, thus facilitating difficult discussions concerning non-physical issues. Unlike oncologists, the PC team is not engaged in the curative effort to fight the disease, and so HP find it easier to discuss to PC staff than with their HO or their family. PC team may allow to engage the patient in “emotional work to facilitate coping, accepting and planning” [35] and to increase prognosis awareness [35]. Patients receiving EIPC who clearly understand their poor prognosis are less likely to receive intravenous chemotherapy near the end of life, whereas understanding of prognosis does not correlate with chemotherapy administration near the end of life for patients receiving standard care [37]. PC could provide keys to enable informed decision-making. Conversion about end-of-life issues is also associated with a decrease in aggressive EoLC, such as a lower rates of ventilation, resuscitation and intensive care unit admissions [38]. Although the prime vocation of PC is not to prolong patient survival, several studies have assessed the impact of EIPC on overall survival, and it has been found that contrary to common belief, patients receiving EIPC do not have higher mortality [34] indeed, several studies have even demonstrated significantly better survival with EIPC [1,33,39,40]. The reason for this survival benefit is probably multifactorial: QoL improvement, decrease in depressive mood, better social support leading to optimal personal care, better understanding of illness prognosis leading to less aggressive care at end of life [41]. Other factors may play a more subjective role, such as patients in PC regaining control of their existence [12]. In addition to the benefit for patients with life-limiting illness, EIPC contributes to caregiver satisfaction. However, the benefit of EIPC on QoL, mood and emotional burden of caregivers varies between studies [34]. The impact of EIPC on resource use and expenditures is also unclear, and requires more investigation [12].

Symptom Burden by Patients with Hematologic Malignancies

Despite the therapeutic improvement, many HP present a high symptom burden, with a mean of 8.8 symptoms [42] since diagnosis [43]. The most frequent symptoms are fatigue, sleep disorders, drowsiness and dry mouth [42]. Fatigue seems to be a multidimensional symptom, and is not exclusively correlated with hemoglobin level [44]. Pain management remains an important issue, with a high prevalence from diagnosis until end of life, especially in certain pathologies like multiple myeloma. For example, 49% of patients with acute leukemia present pain early in the disease course, of which 41% report moderate to severe pain intensity [45]. During the last 3 months of life, more than 83% of patients with lymphoma, leukemia or myeloma present pain, of which 63% describe the pain as distressing [46]. Over the illness course, prevalence of psychological symptoms over the full illness course is high [42,43,45] and may lead to Post-Traumatic Stress Disorder (PTSD) [47,48]. For patients with acute leukemia, depressive symptoms seem to be associated with the symptom burden whereas hopelessness is associated with older age and lower self-esteem [49]. A third of newly-diagnosed acute leukemia patients present a full syndrome or subsyndromal acute stress disorder [50]. Six months after stem cell transplantation, 28% of patients meet criteria for PTSD and 43% suffer from depression. For stem cell transplanted patients, decline of QoL and increase in depressive symptoms are correlated with occurrence of PTSD [47]. In addition, pre-transplantation depression is associated with lower overall survival and higher risk of complications [51]. Another study found that 17% of HM survivors met criteria for PTSD and that fear of recurrence was significantly associated with PTSD occurrence [48]. Patients need honest and comprehensive discussion about their prognosis, and a majority expect the doctor to start the conversation about advance care planning and end-of-life preferences [52]. Very often, it is difficult to explain the reality of prognosis. Indeed, some patients may arrive near death and yet the first round of treatment transforms them and even improves their QoL [53,54]. Despite relapses, they think that treatment will succeed like it did the first time, and so they hold on to an optimistic picture of their prognosis [55]. In this context, patients with HM are more likely to receive invasive or clinical research care near the end of life even if the prognosis is known to be limited [8,56]. HP are referred to hospice services late in the illness course, and are already in poor general condition [57].

The New Clinical Trials in Hematologic Malignancies

A robust literature has highlighted the significant symptom burden in HP. PC teams have strong experience in managing these symptoms (pain, psychological distress) and in improving QoL and prognosis awareness. Early collaboration between PC team and HO, as recently experimented in solid tumors, is entirely viable in HM, especially as the specificities of HM require the experience of a HO and may require the expertise of a PC team. In fact, a few clinical trials have set out to evaluate this strategy. Roeland et al, reported their experience of EIPC for SCT patients. The most common reasons for consultation with PC remained symptom management and psychological distress. Interestingly, SCT patients tended to under-report their symptoms for fear of being undertreated or for fear of disappointing their SCT team and family caregivers. The separation between symptoms management team and SCT team could help overcome patients’ reluctance to express their symptoms of discomfort [58]. Loggers et al, studied the impact of pre-transplantation supportive and PC consultation for patients with high-risk SCT and found no negative impact on hope or mood. Furthermore, a significant number of patients declined to participate, citing “feeling overwhelmed with the pre-transplantation process or the topic of the study or feeling that extra support was not necessary”. In addition, agreement to participate was improved by using the word “supportive” instead of “palliative”, which further confirms the misperceptions by patients and families about PC [59]. There are a tiny handful of prospective trials currently recruiting patients in order to determine the impact of EIPC in HP [60,61] (Table 1).

Table 1: Ongoing Trials.





  

    
STUDY    TYPE

    
PRIMARY    ENDPOINT

    
TIME    FRAME

    
INTERVENTION

    
TESTS

    
PATIENTS

    
DISEASE

    
STATUS

  

  

    
Interventional

    
Successful    enrollment of 30 patient care giver pairs

    
Baseline    to 3 months

    
Care    management by oncology nurses before or after regularly-scheduled oncology    clinic visits

    
    
80

    
Refractory    or recurrent hematologic malignancy

    
Recruiting

  

  

    
Interventional    Randomized

    
Measure    of quality of life

    
12    weeks

    
Supportive    /palliative care intervention at least once a month until the 12th week, more if needed.

    
FACTLeu

    
80

    
Acute    leukemia in relapse

    
Recruiting

  

  

    
Interventional    Randomized

    
Comparison    of the change in patients' FACT Anemia score

    
Baseline    to 6 months

    
Standard    hematology care vs. collaborative    palliative and hematology care

    
FACTLeu

    
140

    
At the    time of diagnosis for myeloid acute leukemia, myelodysplastic syndrome and    DLBCL in relapse

    
Non    Recruiting

  

  

    
Interventional    Randomized

    
Comparison    of the change in patients' FACT Leukemia score

    
2 weeks

    
Standard    leukemia care vs. collaborative    palliative and oncology care

    
FACTLeu

    
160

    
High-risk    acute myeloid leukemia

    
Recruiting

  










Table 1: Ongoing Trials.

References

  1. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010; 363: 733-742.
  2. El-Jawahri A, LeBlanc T, VanDusen H, Traeger L, Greer JA, Pirl WF, et al. Effect of inpatient palliative care on quality of life 2 weeks after hematopoietic stem cell transplantation: A randomized clinical trial. JAMA. 2016; 316: 2094- 2103.
  3. Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, et al. Early palliative care for patients with advanced cancer: a clusterrandomised controlled trial. Lancet. 2014; 383: 1721-1730.
  4. Bakitas M, Lyons KD, Hegel MT, Balan S, Brokaw FC, Seville J, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA. 2009; 302: 741-749.
  5. Smith TJ, Temin S, Alesi ER, Abernethy AP, Balboni TA, Basch EM, et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol. 2012; 30: 880-887.
  6. Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017; 35: 96-112.
  7. Institut de Veille Sanitaire.
  8. Hui D, Didwaniya N, Vidal M, Shin SH, Chisholm G, Roquemore J, et al. Quality of end-of-life care in patients with hematologic malignancies: a retrospective cohort study. Cancer. 2014; 120: 1572-1578.
  9. Odejide OO, Salas Coronado DY, Watts CD, Wright AA, Abel GA. End-of-life care for blood cancers: a series of focus groups with hematologic oncologists. J Oncol Pract. 2014; 10: 396-403.
  10. Howell DA, Shellens R, Roman E, Garry AC, Patmore R, Howard MR. Haematological malignancy: are patients appropriately referred for specialist palliative and hospice care? A systematic review and meta-analysis of published data. Palliat Med. 2011; 25: 630-641.
  11. Hung YS, Wu JH, Chang H, Wang PN, Kao CY, Wang HM, et al. Characteristics of patients with hematologic malignancies who received palliative care consultation services in a medical center. Am J Hosp Palliat Care. 2013; 30: 773-780.
  12. Knoops L, Jacquemin D, Desmedt M. Vers une approche palliative précoce en hématologie. Hématologie. 2016; 22: 188-196.
  13. LeBlanc TW, El-Jawahri A. When and why should patients with hematologic malignancies see a palliative care specialist? Hematol Am Soc Hematol Educ Program. 2015; 2015: 471-478.
  14. LeBlanc TW. Addressing end-of-life quality gaps in hematologic cancers: The importance of early concurrent palliative care. JAMA Intern Med. 2016; 176: 265-266.
  15. LeBlanc TW. In the sandbox: palliative care and hematologic malignancies. J Community Support Oncol. 2014; 12: 44-45.
  16. El-Jawahri AR, Abel GA, Steensma DP, LeBlanc TW, Fathi AT, Graubert TA, et al. Health care utilization and end-of-life care for older patients with acute myeloid leukemia. Cancer. 2015; 121: 2840-2848.
  17. Auret K, Bulsara C, Joske D. Australasian haematologist referral patterns to palliative care: lack of consensus on when and why. Intern Med J. 2003; 33: 566-571.
  18. Lunney JR, Lynn J, Hogan C. Profiles of older medicare decedents. J Am Geriatr Soc. 2002; 50: 1108-1112.
  19. Murray SA, Kendall M, Boyd K, Sheikh A. Illness trajectories and palliative care. BMJ. 2005; 330: 1007-1011. Niscola P, Tendas A, Giovannini M, Scaramucci L, Perrotti A, de Fabritiis P, et al. Caring for terminal patients in hematology: the urgent need of a new research agenda. Support Care Cancer. 2015; 23: 5-7.
  20. Pulte D, Jansen L, Castro FA, Brenner H. Changes in the survival of older patients with hematologic malignancies in the early 21st century. Cancer. 2016; 122: 2031-2040.
  21. McGrath P, Holewa H. Special considerations for hematology patients in relation to end-of-life care: Australian findings. Eur J Cancer Care (Engl). 2007; 16: 164-171.
  22. Manitta VJ, Philip JAM, Cole-Sinclair MF. Palliative care and the hematooncological patient: can we live together? A review of the literature. J Palliat Med. 2010; 13: 1021-1025.
  23. Schenker Y, Crowley-Matoka M, Dohan D, Rabow MW, Smith CB, White DB, et al. Oncologist factors that influence referrals to subspecialty palliative care clinics. J Oncol Pract. 2014; 10: 37-44.
  24. LeBlanc TW, O’Donnell JD, Crowley-Matoka M, Rabow MW, Smith CB, White DB, et al. Perceptions of palliative care among hematologic malignancy specialists: a mixed-methods study. J Oncol Pract. 2015; 11: 230-238.
  25. LeBlanc TW, Smith JM, Currow DC. 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. 2015; 2: 334-338.
  26. Noble S. Palliation for haematological and solid tumours: what difference? Lancet Haematol. 2015; 2: 309-310.
  27. Alt-Epping B, Wulf G, Nauck F. Palliative care for patients with hematological malignancies-a case series. Ann Hematol. 2011; 90: 613-615.
  28. Knoops L, Bastin P. Escalation of commitment in treatment decisions near the end of life. JAMA Oncol. 2017; 3: 1174-1175.
  29. El-Jawahri A, Traeger L, Kuzmuk K, Eusebio J, Vandusen H, Keenan T, et al. Prognostic understanding, quality of life and mood in patients undergoing hematopoietic stem cell transplantation. Bone Marrow Transplant. 2015; 50: 1119-1124.
  30. Beaussant Y, Pazart L, Tournigand C, Mathieu-Nicot F, Cretin E, Deconinck E, et al. The decision to limit or withdraw specific therapies for advanced cancer and hematological malignancies: Physicians and patients points of view and interactions. Blood. 2011; 118: 2076-2086.
  31. Odejide OO, Cronin AM, Condron N, Earle CC, Wolfe J, Abel GA. Timeliness of end-of-life discussions for blood cancers: A national survey of hematologic oncologists. JAMA Intern Med. 2016; 176: 263-265.
  32. Bakitas MA, Tosteson TD, Li Z, Lyons KD, Hull JG, Li Z, et al. Early versus delayed initiation of concurrent palliative oncology care: Patient outcomes in the ENABLE III randomized controlled trial. J Clin Oncol. 2015; 33: 1438- 1445.
  33. Kavalieratos D, Corbelli J, Zhang D, Dionne-Odom JN, Ernecoff NC, Hanmer J, et al. Association between palliative care and patient and caregiver outcomes: A systematic review and meta-analysis. JAMA. 2016; 316: 2104- 2114.
  34. Back AL, Park ER, Greer JA, Jackson VA, Jacobsen JC, Gallagher ER, et al. Clinician roles in early integrated palliative care for patients with advanced cancer: a qualitative study. J Palliat Med. 2014; 17: 1244-1248.
  35. Bandieri E, Sichetti D, Romero M, Fanizza C, Belfiglio M, Buonaccorso L, et al. Impact of early access to a palliative/supportive care intervention on pain management in patients with cancer. Ann Oncol. 2012; 23: 2016- 2020.
  36. Temel JS, Greer JA, Admane S, Gallagher ER, Jackson VA, Lynch TJ, et al. Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care. J Clin Oncol. 2011; 29: 2319-2326.
  37. Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008; 300: 1665-1673.
  38. Higginson IJ, Bausewein C, Reilly CC, Gao W, Gysels M, Dzingina M, et al. An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomized controlled trial. Lancet Respir Med. 2014; 2: 979-987.
  39. Bekelman DB, Plomondon ME, Carey EP, Sullivan MD, Nelson KM, Hattler B, et al. Primary results of the patient-centered disease management (PCDM) for heart failure study: A randomized clinical trial. JAMA Intern Med. 2015; 175: 725-732.
  40. Irwin KE, Greer JA, Khatib J, Temel JS, Pirl WF. Early palliative care and metastatic non-small cell lung cancer: potential mechanisms of prolonged survival. Chron Respir Dis. 2013; 10: 35-47.
  41. Manitta V, Zordan R, Cole-Sinclair M, Nandurkar H, Philip J. The symptom burden of patients with hematological malignancy: a cross-sectional observational study. J Pain Symptom Manage. 2011; 42: 432-442.
  42. Morselli M, Bandieri E, Zanin R, Buonaccorso L, D’Amico R, Forghieri F, et al. Pain and emotional distress in leukemia patients at diagnosis. Leuk Res. 2010; 34: 67-68.
  43. Zordan R, Manitta V, Nandurkar H, Cole-Sinclair M, Philip J. Prevalence and predictors of fatigue in haemo-oncological patients. Intern Med J. 2014; 44: 1013-1037.
  44. Zimmermann C, Yuen D, Mischitelle A, Minden MD, Brandwein JM, Schimmer A, et al. Symptom burden and supportive care in patients with acute leukemia. Leuk Res. 2013; 37: 731-736.
  45. Costantini M, Ripamonti C, Beccaro M, Montella M, Borgia P, Casella C, et al. Prevalence, distress, management, and relief of pain during the last 3 months of cancer patients’ life. Results of an Italian mortality follow-back survey. Ann Oncol. 2009; 20: 729-735.
  46. El-Jawahri AR, Vandusen HB, Traeger LN, Fishbein JN, Keenan T, Gallagher ER, et al. Quality of life and mood predict posttraumatic stress disorder after hematopoietic stem cell transplantation. Cancer. 2016; 122: 806-812.
  47. Black EK, White CA. Fear of recurrence, sense of coherence and posttraumatic stress disorder in haematological cancer survivors. Psychooncology. 2005; 14: 510-515.
  48. Gheihman G, Zimmermann C, Deckert A, Fitzgerald P, Mischitelle A, Rydall A, et al. Depression and hopelessness in patients with acute leukemia: the psychological impact of an acute and life-threatening disorder. Psychooncology. 2016; 25: 979-989.
  49. Rodin G, Yuen D, Mischitelle A, Minden MD, Brandwein J, Schimmer A, et al. Traumatic stress in acute leukemia. Psychooncology. 2013; 22: 299-307.
  50. El-Jawahri A, Chen YB, Brazauskas R, He N, Lee SJ, Knight JM, et al. Impact of pretransplant depression on outcomes of allogeneic and autologous hematopoietic stem cell transplantation. Cancer. 2017; 123: 1828- 1838.
  51. Hancock K, Clayton JM, Parker SM, Wal der S, Butow PN, Carrick S, et al. Truth-telling in discussing prognosis in advanced life-limiting illnesses: a systematic review. Palliat Med. 2007; 21: 507-517.
  52. Sekeres MA, Stone RM, Zahrieh D, Neuberg D, Morrison V, De Angelo DJ, et al. Decision-making and quality of life in older adults with acute myeloid leukemia or advanced myelodysplastic syndrome. Leukemia. 2004; 18: 809- 816.
  53. Merli F, Bertini M, Luminari S, Mozzana R, Bertè R, Trottini M, et al. Quality of life assessment in elderly patients with aggressive non-Hodgkin’s Lymphoma treated with anthracycline-containing regimens. Report of a prospective study by the Intergruppo Italiano Linfomi. Haematologica. 2004; 89: 973-978.
  54. Lee SJ, Fairclough D, Antin JH, Weeks JC. Discrepancies between patient and physician estimates for the success of stem cell transplantation. JAMA. 2001; 285: 1034-1038.
  55. Ho TH, Barbera L, Saskin R, Lu H, Neville BA, Earle CC. Trends in the aggressiveness of end-of-life cancer care in the universal health care system of Ontario, Canada. J Clin Oncol. 2011; 29: 1587-1591.
  56. LeBlanc TW, Abernethy AP, Casarett DJ. What is different about patients with hematologic malignancies? A retrospective cohort study of cancer patients referred to a hospice research network. J Pain Symptom Manage. 2015; 49: 505-512.
  57. Roeland E, Ku G. Spanning the canyon between stem cell transplantation and palliative care. Hematol Am Soc Hematol Educ Program. 2015; 2015: 484-489.
  58. Loggers ET, LeBlanc TW, El-Jawahri A, Fihn J, Bumpus M, David J, et al. Pretransplantation supportive and palliative care consultation for high-risk hematopoietic cell transplantation patients. Biol Blood Marrow Transplant. 2016; 22: 1299-1305.
  59. Supportive care intervention in patients hospitalized for hematopoietic stem cell transplantation (SHIELD).
  60. Barbaret C, Berthiller J, Schott Pethelaz AM, Michallet M, Salles G, Sanchez S, et al. Research protocol on early palliative care in patients with acute leukaemia after one relapse. BMJ Support Palliat Care. 2017; 7: 480-484.
  61. Early palliative care for patients with haematological malignancies. CALVI.

Citation: Bounaix L, Guastella V, Bay JO, Bordessoule D and Moreau S. Early Palliative Care in Hematologic Malignancies a Review of Current Knowledge. Ann Hematol Oncol. 2019; 6(8): 1263.