Article summary written by Kate O’Rourke
“Differences in attitudes and beliefs toward end-of-life care between hematologic and solid tumor oncology specialists” published in the Annals of Oncology
Compared with patients who have solid tumors, individuals with hematologic malignancies are more likely to receive aggressive interventions at the end‑of‑life and thus have a worse quality of life (QOL). Now, a new study in the Annals of Oncology (2015;26(7):1440-1446) suggests a possible reason for this: hematologists are less comfortable with death and have a greater sense of self-blame when treatments are not able to alter the course of disease.
In the study, researchers from the University of Texas MD Anderson Cancer Center, in Houston, randomly surveyed 120 hematologic specialists and 120 solid tumor specialists in the United States about various aspects of end‑of‑life care. On a scale of 1 (strongly against) to 7 (strongly recommend), hematologists were far more likely to prescribe systemic therapy with moderate toxicity and no survival benefit for patients with poor performance status (Eastern Cooperative Oncology Group 4) and an expected survival of one month (median score, 4 vs. 1). The American Society of Clinical Oncology considers administering systemic cancer therapy in the last month of life poor quality of care.
The survey also showed that clinicians specializing in hematologic malignancies felt less comfortable discussing death and dying (72% vs. 88%; P=.007) and hospice (81% vs. 93%; P=.02). Hematologists were more likely to feel a sense of failure after disease progression (46% vs. 31%; P=.04). While the study suggests that clinician attitudes play a role in the different end-of-life care patterns of hematologists and oncologists, other factors may also contribute, including patient characteristics, disease trajectory, perceived prognosis, and treatment risks and benefits.
The researchers say that specific interventions aimed at hematologic specialists to help improve end‑of‑life discussions may improve the quality of life for patients with very limited lifespans. Improving these discussions could decrease the high rates of hospitalizations seen in patients with hematologic malignancies at the end of life and increase the use of palliative and hospice care. Policies focused on enhancing the palliative care workforce, investing in palliative care research, and increasing the availability of palliative care services are needed.
To access the Pub Med Abstract please visit the link below:
Additional tools and educational activities related to palliative care:
Serious Illness Conversation Guide (PDF download)
The Serious Illness Conversation Guide is a tool to help clinicians’ foster end-of-life discussions with their patients. The guide was developed by researchers from Dana-Farber Cancer Institute and Ariadne Labs.
Accredited eNewsletter Activity:
Fast Facts in Palliative Care: A Focus on Pancreatic Cancer
View this accredited activity to learn more about the important role of palliative care in improving QOL for your patients with pancreatic cancer.