Abstract
Hematopoietic stem cell or bone marrow transplantation (BMT) is one of the most promising and potentially curative therapeutic options available for eligible patients with hematologic malignancies (HMs) or leukemias. However, the nature and clinical course of HMs, specifically for patients undergoing BMT, are associated with significant morbidity, symptomatology, healthcare service utilization, psychosocial and end of life issues, and overall decreased quality of life. Early palliative care (PC) consultations and utilization for patients with HMs have been shown to improve patient outcomes, satisfaction, and autonomy as well as caregiver burden, shared-decision making, and holistic care management. Despite the complexity of care and complications for patients with HM undergoing BMT, early PC interventions are systematically underutilized and understudied in this population compared to patients with solid tumors or non-HMs. Herein, the authors reviewed the current literature and knowledge to assess and report the perceptions and barriers to early PC utilization in the care of patients with HMs undergoing BMT. Clinical and cultural aspects of PC perceptions as well as current PC care models and potential directions for PC implementation were reviewed to inform future research studies and clinical practice guidelines necessary for the improvement of care and quality of life for HM patients undergoing BMT.
Highlights
BackgroundHematologic malignancies (HMs), or leukemias, are a common form of cancer in the United States, with over 60,000 estimated new cases in 2019 and over 400,000 individuals living with a form of leukemia in 2016 [1]
Patients living with hematologic malignancies (HMs) and undergoing bone marrow transplantation (BMT) are significantly more likely to receive aggressive care toward the end of life and are more likely to have reduced quality of life near the end of life as compared to patients with solid tumors. These findings are associated with the severity of treatment-related complications of a BMT, which contributes to the symptomatology and aggressive treatments these patients experience
Further efforts should be aimed at improving the understanding of perceptions from both patient and provider perspectives regarding palliative care (PC) interventions to develop a care model integrating PC services with the care of patients with HM undergoing BMT
Summary
Hematologic malignancies (HMs), or leukemias, are a common form of cancer in the United States, with over 60,000 estimated new cases in 2019 and over 400,000 individuals living with a form of leukemia in 2016 [1]. The intensive care and monitoring required during the first few years post-BMT to manage symptoms, complications, morbidity, and mortality emphasize the need for a better understanding of barriers and perceptions regarding early PC interventions for this patient population Improving this understanding can inform future studies and models on the necessary considerations for implementing PC for HM patients undergoing BMT to improve health outcomes and maximize quality of life and care. One study demonstrates that African Americans lack accessibility to pain medication because they tend to live in areas where pharmacies do not supply opioids [12] Despite these physical barriers and disparities, an improved understanding of the influence of culture in PC will likely bridge the gap between the care received by racial/ethnic minorities relative to Whites. This supports the proposition that PC serves a key, adjunctive role to standard oncological care in the management of difficult cases and should be explored further in patients with HMs undergoing BMT [23]
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