Impact of integrated palliative care in acute and aggressive medical care for patients with advanced haematological malignancies: a retrospective matched case-control study

BackgroundAggressive medical care can increase suffering and the health-care burden on patients with advanced haematological malignancies. Our palliative care team has been pioneering an integrated palliative care (IPC) programme for patients with advanced haematological malignancies in Hong Kong since 2018. The aim of the study was to evaluate the effect of IPC on the administration of chemotherapy or other treatments within the 14 days before death; multiple (more than one) emergency department visits within the 90 days before death; multiple (more than one) unplanned hospitalisations within the 90 days before death; and intensive care unit admission within the 90 days before death.MethodsWe retrospectively reviewed the outcomes of patients with advanced haematological malignancies who received IPC during the period of Jan 1, 2017, to Dec 31, 2020. Patients who died on the day of referral to palliative care or younger than 18 years were excluded. Our IPC programme comprised: early palliative care referral and advance care planning discussions; baseline and regular assessment of patient's physical and psychospiritual distress and family concerns; consensus for symptom management and supportive services; and regular meetings with haematologists to review and modify care plans for their patients and community providers. Patients matched by disease status and patient characteristics but who did not receive IPC were selected as control in a 1:2 ratio. Descriptive statistics were used to illustrate general patient characteristics, stratified by matching group. Multivariate analyses were used to assess the effect of IPC on the outcomes of interest. The effect of duration of IPC on patient outcomes was also investigated. Ethical approval for this study was issued by the Institutional Review Board of the University of Hong Kong and Hospital Authority Hong Kong West Cluster (reference UW 18–282).Findings317 patients with advanced haematological malignancies (of whom 105 received IPC) were included for analysis. The primary diagnosis was lymphoma (134 [42%] of 317 patients), leukaemia (106 [33%]), myelodysplastic syndrome (46 [15%]), and myeloma (31 [10%]). The use of IPC was associated with less multiple emergency department visits (odds ratio 0·19 [95% CI 0·16–0·23]; p=0·019], reduced multiple unplanned hospitalisations (0·24 [0·19–0·31]; p=0·0021), and lower risk of intensive care unit admission (0·12 [0·08–0·18]; p=0·0032) within the 90 days before death, and decreased need of chemotherapy or other treatments within the 14 days before death (0·34 [0·25–0·46]; p=0·0012). Receiving IPC for more than 90 days was associated with 2% fewer multiple emergency department visits, 12% less multiple unplanned hospitalisations, 3% less intensive care unit admissions, and 11% less need of chemotherapy or other treatments in the defined near-death intervals.InterpretationThis study was limited by its retrospective design and the scarcity of details on the frequency and intensity of the palliative care service. Despite these limitations, we found that the use of IPC service was associated with reduced need for acute and aggressive medical services in patients with advanced haematological malignancies.FundingNone.