Timing of referral to outpatient palliative care for patients with haematologic malignancies.

in British journal of haematology by Sameer Patel, Geordyn Hoge, Bryan Fellman, Sharanpreet Kaur, Yvonne Heung, Eduardo Bruera, David Hui

TLDR

  • The study examines the trend in timing of outpatient palliative-care referrals over 10 years in patients with haematologic malignancies, finding a significant increase in referrals and timely access to care.

Abstract

Outpatient palliative-care facilitates timely supportive-care access; however, there is a paucity of studies on the timing of referral in the outpatient setting for patients with haematologic malignancy. We examined the trend in timing of outpatient palliative-care referrals over a 10-year period in patients with haematologic malignancies at our comprehensive cancer centre. We included consecutive patients with a diagnosis of haematologic malignancy who were seen at our outpatient palliative-care clinic between 1 January 2010 and 31 December 2019. We collected data on patient characteristics, symptom burden and supportive-care interventions at outpatient palliative-care consultation. The primary outcome was time from outpatient palliative-care consultation to death or last follow-up. In all, 384 patients were referred by leukaemia (n = 143), lymphoma (n = 213), and stem cell transplant (n = 28) services. The median time from outpatient palliative-care referral to death was 3.4 years (IQR 2.4-5.3) with a significant increase in both the number of referrals per year (p = 0.047) and the timing of referral between 2010 and 2019 (p = 0.001). Patients with haematologic malignancies were referred in a timely fashion to our outpatient palliative-care clinic, with earlier and greater numbers of referrals over time.

Overview

  • The study examined the trend in timing of outpatient palliative-care referrals over a 10-year period in patients with haematologic malignancies at a comprehensive cancer centre.
  • The study included consecutive patients with a diagnosis of haematologic malignancy who were seen at the outpatient palliative-care clinic between 2010 and 2019.
  • The primary objective was to investigate the time from outpatient palliative-care consultation to death or last follow-up in patients with haematologic malignancy.

Comparative Analysis & Findings

  • The study found a significant increase in the number of referrals per year and the timing of referral between 2010 and 2019 (p = 0.001)
  • The median time from outpatient palliative-care referral to death was 3.4 years (IQR 2.4-5.3) with a significant increase over time.
  • Patients with haematologic malignancies were referred in a timely fashion to the outpatient palliative-care clinic, with earlier and greater numbers of referrals over time.

Implications and Future Directions

  • The study highlights the importance of timely referrals to outpatient palliative-care for patients with haematologic malignancy, as delayed referrals may exacerbate symptom burden and disease progression.
  • Future studies should investigate the factors contributing to the increased trend in referrals and explore strategies to further improve timely access to palliative care.
  • The study's findings underscore the need for continuous quality improvement initiatives to optimize palliative care services and patient outcomes.
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