title: Intensive palliative care for patients with hematological cancer dying in hospice: analysis of the level of medical care in the final week of life.
abstract: Dying of hematological oncology patients often take place in respective hematology ward or intensive care unit rather than hospice. With the increased attention to quality palliative care for hematology patients, concerns regarding their level of medical care at end-of-life need to be addressed. We conducted a retrospective review of consecutive hematological oncology patients who succumbed in a palliative unit between July 2012 and August 2013. The primary outcome measure was their level of medical care received, including administration of antibiotics, total parenteral nutrition, blood sampling, GCSF injection and blood products transfusion, during their last seven days of life. During the last seven days of life, 85.7 % of patients had blood sampling and 23.8% of patients received G-CSF injection. Total parenteral nutrition was administered in 14.3% of patients. One-third of patients received transfusion of packed cells and nearly half of them received transfusion of platelet concentrates. Almost 90% of patients received antibiotics during their last week of life. Collaboration between hematology and palliative care has resulted in successful transition of hematologic cancer patients into hospice unit in their terminal phase of illness. However, their level of medical care, even approaching last seven days of life, remained intensive. Proper allocation of medical resources and future research regarding optimal end-of-life care for hematology patients are warranted.
authors.affiliation: Palliative Medical Unit, Grantham Hospital, 125 Wong Chuk Hang Road, Aberdeen, Hong Kong SAR, China Department of Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR, China benchw@hkstar.com.
authors.forename: Benjamin Hon Wai
authors.initials: BH
authors.lastname: Cheng
authors.affiliation: Palliative Medical Unit, Grantham Hospital, 125 Wong Chuk Hang Road, Aberdeen, Hong Kong SAR, China.
authors.forename: Michael Mau Kwong
authors.initials: MM
authors.lastname: Sham
authors.affiliation: Palliative Medical Unit, Grantham Hospital, 125 Wong Chuk Hang Road, Aberdeen, Hong Kong SAR, China.
authors.forename: Kwok Ying
authors.initials: KY
authors.lastname: Chan
authors.affiliation: Palliative Medical Unit, Grantham Hospital, 125 Wong Chuk Hang Road, Aberdeen, Hong Kong SAR, China.
authors.forename: Cho Wing
authors.initials: CW
authors.lastname: Li
authors.affiliation: Department of Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR, China.
authors.forename: Ho Yan
authors.initials: HY
authors.lastname: Au
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D019337:Hematologic Neoplasms / Q000628:therapy*; D006403:Hematologic Tests / Q000706:statistics & numerical data; D006723:Hong Kong; D017051:Hospice Care / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D010289:Parenteral Nutrition, Total / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013727:Terminal Care / Q000706:statistics & numerical data*
chemical_list: D000900:Anti-Bacterial Agents; D016179:Granulocyte Colony-Stimulating Factor
keywords: dying; hematology; hospice; intensive; oncology; palliative care