title: End-of-life characteristics and palliative care provision for elderly patients suffering from acute myeloid leukemia.
abstract: OBJECTIVE
  End-of-life care characteristics and palliative care (PC) utilization of elderly acute myeloid leukemia (AML) patients have rarely been reported. The aim of this study was to evaluate the cause of death, place of death and PC utilization of older adults (age 60 years or above) suffering from AML.
  
  
  METHODS
  Patients were recruited retrospectively from two hematology units in Hong Kong, which consisted of one university department with Bone Marrow Transplant service, and one regional hospital with hematology specialty service. Collaboration with PC unit was established. Elderly AML patients referred to PC service were included. Medical records of all identified patients would be reviewed retrospectively by two PC physicians.
  
  
  RESULTS
  From October 2011 to April 2013, 156 hematological cancer patients were referred for PC; 43 elderly AML patients were included into data analysis. The median time from AML diagnosis to death was 9.1 months. Up to 46.5% patients received supportive care alone since diagnosis. More than half of elderly AML patients died in acute ward and hematology units (53.5 %), while 30.2 % died in PC settings. Overall, 51.2% of patients spent the whole period of their final month of life in-hospital. Infection-related diagnoses contributed to 51.2% of deaths. Median time from AML diagnosis to first PC consultation was 1.0 month. PC service includes psychosocial support (100%), hospice in-patient care (30.2%), homecare (60.5%), PC outpatient clinic (14.0%) and bereavement care (93.0%).
  
  
  CONCLUSIONS
  Elderly AML patients carry dismal prognosis with their final phase of disease mostly hospitalized in acute care settings. Infections and bleeding could complicate course of illness and lead to rapid deterioration. PC collaboration remains important in psychosocial support and coverage of dying AML patients in non-hospice settings.
authors.affiliation: Palliative Medical Unit, Grantham Hospital, 125 Wong Chuk Hang Road, Aberdeen, Hong Kong, SAR, China, benchw@hkstar.com.
authors.forename: Hon-Wai Benjamin
authors.initials: HW
authors.lastname: Cheng
authors.forename: Cho-Wing
authors.initials: CW
authors.lastname: Li
authors.forename: Kwok-Ying
authors.initials: KY
authors.lastname: Chan
authors.forename: Ho-Yan
authors.initials: HY
authors.lastname: Au
authors.forename: Pan-Fong
authors.initials: PF
authors.lastname: Chan
authors.forename: Yim-Ching
authors.initials: YC
authors.lastname: Sin
authors.forename: Yan
authors.initials: Y
authors.lastname: Szeto
authors.forename: Mau-Kwong
authors.initials: MK
authors.lastname: Sham
mesh_terms: D000368:Aged; D000375:Aging; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data; D006723:Hong Kong; D017051:Hospice Care / Q000706:statistics & numerical data*; D006738:Hospices; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D010166:Palliative Care / Q000706:statistics & numerical data*; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D019452:Terminally Ill