The last days of patients with non-Hodgkin’s lymphoma - analysis of a sample of deceased patients over a period of 6 years (2012-2017) at one institution and the role of integrating palliative care
Authors:
R. Urbanová 1; R. Machová 1; R. Szotkowská 1; V. Procházka 1; M. Labudíková 1; M. Hošťálková 2; A. Hluší 1; T. Papajík 1; O. Sláma 3
Authors‘ workplace:
Hemato-onkologická klinika Fakultní nemocnice Olomouc a Lékařská fakulta, Univerzita Palackého v Olomouci, Olomouc
1; Jsme blízko vám – Institut klinické pastorační péče, z. ú., Olomouc
2; Klinika komplexní onkologické péče, Masarykův onkologický ústav, Brno
3
Published in:
Transfuze Hematol. dnes,26, 2020, No. 2, p. 113-123.
Category:
Original Papers
Overview
Background: Despite the achievements of modern haemato-oncology, non-Hodgkin´s lymphoma remains a potentially life-threatening disease. Population aging and the prolonged survival of patients with haematological malignancy place increasing demands on health care, including decisions as to the type of treatment and care. In haemato-oncology, palliative care is the subject of much discussion, both in literature and practice. This discussion is affected by the difficulties in determining prognosis, the many treatment options available including targeted treatment, the personal standpoints of haematologists themselves, patient transfusion dependence and the limited experience of hospices with haematologically ill patients. There is a lack of studies showing the benefits of palliative care in these patients compared to patents with solid tumours.
Methods: We analysed the last 6 months, 3 months and 1 month of life of 72 treated and deceased patients with non-Hodgkin's lymphoma at the Haemato-oncology Clinic of the University Hospital Olomouc over 6 years (2012–2017).
Results: The place of death was in 90% the hospital, 47% of the patients died directly at the clinic. 43% of the patients died during curative treatment, 57% died during palliative treatment. 29% of the patients had relapsed disease and 29% of the patients were refractory to chemotherapy at the time of death, while 27% died during first-line treatment. In the last 30 days of life, 25 (37%) patients received chemotherapy, 15 patients were in curative and 10 in palliative care. In the last 7 days of life, only 5 (7%) patients were receiving curative chemotherapy. The median number of hospitalizations in the last 6 months of life was 3 (range 0–7). The median days of hospitalization in the last 6 months of life were 32 days (range 0–118), 25 days (range 0–90) in the last 3 months of life, and 11 days (range 0–31) in the last month of life. The median overall survival from diagnosis was 9.2 months.
Conclusion: Despite all the successes of modern haemato-oncology, Non-Hodgkin's lymphoma remains a potentially life-threatening disease. Its treatment is associated with a significant symptom burden and intensive end-of-life care. Some patients receive chemotherapy at the end of their lives, frequent hospitalization is needed, some patients die as a direct result of the disease or its complications, most often in hospital. We believe that comprehensive care for patients with non-Hodgkin's lymphomas should include palliative care, both end-of-life care and early palliative care, in addition to modern anti-cancer therapy.
Keywords:
haemato-oncology – palliative care integration – non-Hodgkin’s lymphoma – end-of-life care (EoLC)
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