title: When and why should patients with hematologic malignancies see a palliative care specialist?
abstract: Palliative care is a multidisciplinary approach to symptom management, psychosocial support, and assistance in treatment decision-making for patients with serious illness and their families. It emphasizes well-being at any point along the disease trajectory, regardless of prognosis. The term "palliative care" is often incorrectly used as a synonym for end-of-life care, or "hospice care". However, palliative care does not require a terminal diagnosis or proximity to death, a misconception that we will address in this article. Multiple randomized clinical trials demonstrate the many benefits of early integration of palliative care for patients with cancer, including reductions in symptom burden, improvements in quality-of-life, mood, and overall survival, as well as improved caregiver outcomes. Thus, early concurrent palliative care integrated with cancer-directed care has emerged as a standard-of-care practice for patients with cancer. However, patients with hematologic malignancies rarely utilize palliative care services, despite their many unmet palliative care needs, and are much less likely to use palliative care compared to patients with solid tumors. In this article, we will define "palliative care" and address some common misconceptions regarding its role as part of high-quality care for patients with cancer. We will then review the evidence supporting the integration of palliative care into comprehensive cancer care, discuss perceived barriers to palliative care in hematologic malignancies, and suggest opportunities and triggers for earlier and more frequent palliative care referral in this population.
authors.affiliation: Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC; and.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: LeBlanc
authors.affiliation: Department of Medicine, Harvard Medical School, Division of Hematologic Malignancies, Massachusetts General Hospital Cancer Center, Boston, MA.
authors.forename: Areej
authors.initials: A
authors.lastname: El-Jawahri
mesh_terms: D001294:Attitude to Health; D003657:Decision Making; D019317:Evidence-Based Medicine; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D008495:Medical Oncology / Q000379:methods; D010166:Palliative Care / Q000379:methods* / Q000592:standards; D011379:Prognosis; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation; D000078329:Workforce