A systematic review of prognostic factors at the end of life for people with a hematological malignancy.
Accurate prognosticating is needed when patients are nearing the end of life to ensure appropriate treatment decisions, and facilitate palliative care provision and transitioning to terminal care. People with a hematological malignancy characteristically experience a fluctuating illness trajectory leading to difficulties with prognosticating. The aim of this review was to identify current knowledge regarding 'bedside' prognostic factors in the final 3 months of life for people with a hematological malignancy associated with increased risk of mortality.



A systematic review of the literature was performed across: PubMed; CINAHL; PsycINFO; and Cochrane with set inclusion criteria: 1) prognostic cohort studies; 2) published 2004-2014; 3) sample ≥ 18 years; 4) >50% sample had a hematological malignancy; 5) reported 'bedside' prognostic factors; 6) median survival of <3 months; and 7) English language. Quality appraisal was performed using the Quality In Prognostic Studies (QUIPS) tool. Results are reported in line with PRISMA guidelines.



The search returned 4860 studies of which 28 met inclusion criteria. Twenty-four studies were rated moderate quality, three were high quality and one study was deemed to be of low quality. Most studies were set in the ICU (n = 24/28) and were retrospective (n = 25/28). Forty 'bedside' prognostic factors were identified as associated with increased risk of mortality encompassing the following broad categories: 1) demographics; 2) physiological complications or conditions; 3) disease characteristics; 4) laboratory blood values; and 5) interventions.



The literature on prognosticating in the final months of life was predominantly focused on people who had experienced acute physiological deterioration and were being treated aggressively in the in-patient setting. A significant gap in the literature exists for people who are treated less aggressively or are on a palliative trajectory. Findings did not report on, or confirm the significance of, many of the key prognostic factors associated with increased risk of mortality at the end of life in the solid tumour population, demonstrating key differences in the two populations.



This systematic review was not registered.
Royal Brisbane and Women's Hospital, Bowen Bridge Road, Level 5, Block 34, Brisbane, QLD, 4006, Australia. elise.button@student.qut.edu.au.
Elise
0000-0001-8240-8699
E
Button
Royal Brisbane and Women's Hospital, Bowen Bridge Road, Level 5, Block 34, Brisbane, QLD, 4006, Australia.
Raymond Javan
RJ
Chan
Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Brisbane, QLD, 4059, Australia.
Shirley
S
Chambers
Royal Brisbane and Women's Hospital, Bowen Bridge Road, Level 5, Joyce Tweddell Building, Brisbane, QLD, 4006, Australia.
Jason
J
Butler
Queensland University of Technology, Victoria Park Road, N Block, Brisbane, QLD, 4059, Australia.
Patsy
P
Yates
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019337:Hematologic Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011379:Prognosis; D055815:Young Adult
End of life; Hematological malignancies; Palliative care; Prognostic factors