title: Haematological malignancy: are patients appropriately referred for specialist palliative and hospice care? A systematic review and meta-analysis of published data.
abstract: Haematological malignancies are complex diseases, affecting the entire age spectrum, and having marked differences in presentation, treatment, progression and outcome. Patients have a significant symptom burden and despite treatment improvements for some sub-types, many patients die from their disease. We carried out a systematic review and meta-analysis to examine the proportion of patients with haematological malignancies that received any form of specialist palliative or hospice care. Twenty-four studies were identified, nine of which were suitable for inclusion in the meta-analysis. Our review showed that patients with haematological malignancies were far less likely to receive care from specialist palliative or hospice services compared to other cancers (Risk Ratio 0.46, [95% confidence intervals 0.42-0.50]). There are several possible explanations for this finding, including: ongoing management by the haematology team and consequent strong bonds between staff and patients; uncertain transitions to a palliative approach to care; and sudden transitions, leaving little time for palliative input. Further research is needed to explore: transitions to palliative care; potential unmet patient needs; where patients want to be cared for and die; existing practices in the delivery of palliative and end-of-life care; and barriers to specialist palliative care and hospice referral and how these might be overcome.
authors.affiliation: Epidemiology and Genetics Unit, Department of Health Sciences, Seebohm Rowntree Building, University of York, UK. debra.howell@egu.york.ac.uk
authors.forename: Debra A
authors.initials: DA
authors.lastname: Howell
authors.forename: Rhiannon
authors.initials: R
authors.lastname: Shellens
authors.forename: Eve
authors.initials: E
authors.lastname: Roman
authors.forename: Anne C
authors.initials: AC
authors.lastname: Garry
authors.forename: Russell
authors.initials: R
authors.lastname: Patmore
authors.forename: Martin R
authors.initials: MR
authors.lastname: Howard
mesh_terms: D001291:Attitude of Health Personnel; D017281:Cost of Illness; D019337:Hematologic Neoplasms; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D015201:Meta-Analysis as Topic; D010166:Palliative Care / Q000458:organization & administration*; D010346:Patient Care Management / Q000458:organization & administration*; D011788:Quality of Life; D012017:Referral and Consultation / Q000592:standards* / Q000639:trends; D013038:Specialization; D059039:Standard of Care