Palliative Care vs Standard of Care in Discussion of End-of-Life Care Preferences for Patients With AML and MDS
Areej El-Jawahri, MD, Massachusetts General Hospital, Boston, Massachusetts, discusses results from a clinical trial comparing a collaborative palliative and oncology care model vs usual care for adult patients with acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS).
The study showed that palliative care significantly improved the rates of discussion and documentation of end-of-life (EOL) care preferences, reduced hospitalization at the EOL, and improved the quality of life in patients.
These results were presented at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, Illinois.
Transcript:
Good morning. My name is Areej El-Jawahri. I'm one of the oncologists at Mass[achusetts] General Hospital in Boston, and I specialize in the care of patients with blood cancers, and welcome to [the American Society of Clinical Oncology] ASCO 2024.
I'm excited today to speak to you about a multi-site, randomized clinical trial that was done at Mass[achusetts] General [Hospital] and the Ohio State University, focused on addressing the palliative and supportive care needs of patients with acute leukemia and [myelodysplastic syndrome] MDS.
We know patients with AML, acute myeloid leukemia, and high-risk MDS have a lot of physical and psychological symptoms during their treatment course. We also know that patients with hematological malignancies, particularly those with AML and MDS, receive intensive and costly care at the end of life that often is not concordant with their preferences and wishes. We also know that we don't engage these patients and families in meaningful discussions about their end-of-life care preferences.
In this study, we try to understand whether an early palliative care intervention [and] integrating specialty palliative care clinicians in the care of patients with AML and MDS can improve the quality of their end-of-life care as well as overall quality of life. This was a multi-site, randomized clinical trial, including 115 patients with acute myeloid leukemia and MDS receiving non-intensive chemotherapy.
Patients were randomly assigned to a palliative care intervention that included both an outpatient palliative care component as well as an inpatient palliative care component because we know these patients spend a lot of time in the hospital setting. Patients randomized to usual care received all the supportive care measures offered by the leukemia team. In addition, they were allowed and permitted to consult palliative care upon request.
However, we know in this population, palliative care is rarely utilized. The primary outcome of the study was the time from documentation of end-of-life care preferences to death because we know these patients rarely discuss their end-of-life care preferences and often have these conversations very late in the illness course.
In this study, we found that patients randomized to the palliative care intervention had a much earlier time from documentation of end-of-life care preferences to death about 41 days compared to 1.5 days in the usual care group. They were also more likely to discuss their end-of-life care preferences and were less likely to experience hospitalizations in the last 30 days of life. We also know that from this patient population, those receiving the palliative care intervention had improvement in their overall quality of life compared to those receiving usual care.
Based on the findings of this study and other studies in the context of hematological malignancies, we can now definitively state that early palliative care integration in the care of these patients improve not only their quality of life and psychological symptoms, but also the quality of their end-of-life care; So, this should become the standard of care for this population.
Source:
El-Jawahri A, Kavanaugh A, Greer J, et al. Multi-site randomized trial of a collaborative palliative and oncology care model for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) receiving non-intensive therapy. Presented at the ASCO Annual Meeting. May 31–June 4, 2024; Chicago, IL. Abstract LBA6508
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