|LETTERS TO EDITOR
|Year : 2021 | Volume
| Issue : 1 | Page : 151-153
Palliative and symptom-directed care at diagnosis in hematologic malignancies: Need for hematology-oncology and anesthesia-pain services to join forces
Department of Clinical Hematology and Stem Cell Transplantation, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
|Date of Submission||18-Feb-2021|
|Date of Decision||05-Mar-2021|
|Date of Acceptance||05-Mar-2021|
|Date of Web Publication||26-Mar-2021|
Department of Clinical Hematology and stem cell transplantation, Dayanand Medical college and hospital, Ludhiana, Punjab
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh S. Palliative and symptom-directed care at diagnosis in hematologic malignancies: Need for hematology-oncology and anesthesia-pain services to join forces. Cancer Res Stat Treat 2021;4:151-3
|How to cite this URL:|
Singh S. Palliative and symptom-directed care at diagnosis in hematologic malignancies: Need for hematology-oncology and anesthesia-pain services to join forces. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Apr 22];4:151-3. Available from: https://www.crstonline.com/text.asp?2021/4/1/151/312104
Palliative care is defined by the World Health Organization (WHO) as any intervention that improves the quality of life (QOL) of patients and their families when faced with a life-threatening illness by identification and assessment of pain and other physical, psychosocial, and spiritual issues. In clinical practice, however, this term has become synonymous with “end-of-life” care, with the intent of addressing patient symptoms at the last stage of the illness, in the setting of advanced disease. In this setting, the wishes of the patients and their families often take a backseat, and minimal emphasis is placed on improving their QOL. While undergoing treatment for malignancies, patients often report feeling distressed when their QOL, symptoms, and wishes are not addressed adequately., This has inspired a number of studies addressing the routine integration of palliative care with oncology care services, leading to the concept of “primary palliative care.” Primary palliative care has come to be defined as care provided by the treating physician at the time of diagnosis and initiation of therapy, rather than in later stages.
The importance of initiation of palliative care at an early stage in the disease course rather than at the end of life has been increasingly understood over the past decade. Three major trials have highlighted the importance of the early integration of palliative care with routine treatment in solid organ malignancies, and reported an improvement in various QOL measures. This is consistent with the WHO definition to provide multifaceted care for various issues that a patient or caregiver may face. One of these trials conducted by Bakitas et al. in 2009 included patients with newly diagnosed solid organ malignancies with expected survival <1 year; the study showed significant improvement in scores for QOL and mood. Similar results were reported by Zimmerman et al., in terms of QOL measures. Temel et al., in addition to the above measures, also reported an improvement in overall survival in patients with non-small cell lung cancer when palliative care was introduced early. This has created an impetus for early integration of palliative care in clinical oncology services. In the USA, guidelines by the American Society of Clinical Oncology call for the integration of palliative care early in the management of the primary cancer. An update in 2017 has emphasized the need for referral to specialized teams early in the disease course.
However, specialized palliative care services are few and far between. Even in the developed countries, there is a significant shortage of palliative care physicians, infrastructure and the availability of palliative care, making it impossible for every patient to receive specialized care., In the Indian setting, there are very few specialized palliative care physicians or nurses, a fact which is further hampered by our variations in socioeconomic status, population density, and lack of national-level policies. There is a huge unmet need in India in this setting. In the absence of specialty physicians and nurses well versed with this subject, it is often the onus of the primary care physician to provide palliative care services. However, with the development of multidisciplinary cancer centers, it is often possible to enable these services with a team consisting of the anesthetist/pain specialist, oncologist, oncology nurse, and psychiatrist/psychologist in India.
Patients with hematologic malignancies have unique needs compared to those with solid organ malignancies, with a much higher incidence of symptoms due to neutropenia, mucositis, and bleeding. The symptom burden in these patients due to primary disease and chemotherapy is distinctive. Different hematologic malignancies have varying rates of progression and require different intensities of chemotherapy. Many times, older patients with advanced malignancies are not candidates for intensive therapy and are on palliative chemotherapy alone. Older patients with advanced hematologic malignancies usually do not receive high-quality end-of-life care. In addition, palliative chemotherapy and transfusions may play a unique role in hematologic malignancies, one that is not seen in other disorders. A wide range of overall survival from a few weeks to many years for a hematologic cancer creates different palliative care needs for varying groups of patients. Preliminary data from our department (unpublished) have revealed a significant negative effect on QOL of hematology-oncology patients at diagnosis, as measured by the Functional Assessment of Cancer Therapy questionnaire; the manuscript is under prospective compilation.
There are no studies evaluating the effects of early palliative care integration in patients with hematologic malignancies, particularly in the Indian setting. Patients with blood cancers and those undergoing a stem cell transplantation represent a unique patient population. An integrative approach, with inputs from anesthesiology/pain/palliative care services, neurology, psychiatry, and nursing along with the primary care physician, has the potential to improve the QOL of patients with hematologic cancers and should be high on the agenda for research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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