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End-of-life characteristics and palliative care provision for elderly patients suffering from acute myeloid leukemia

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Abstract

Purpose

End-of-life care characteristics and palliative care (PC) utilization of elderly acute myeloid leukemia (AML) patients have rarely been reported. The aim of this study was to evaluate the cause of death, place of death and PC utilization of older adults (age 60 years or above) suffering from AML.

Methods

Patients were recruited retrospectively from two hematology units in Hong Kong, which consisted of one university department with Bone Marrow Transplant service, and one regional hospital with hematology specialty service. Collaboration with PC unit was established. Elderly AML patients referred to PC service were included. Medical records of all identified patients would be reviewed retrospectively by two PC physicians.

Results

From October 2011 to April 2013, 156 hematological cancer patients were referred for PC; 43 elderly AML patients were included into data analysis. The median time from AML diagnosis to death was 9.1 months. Up to 46.5 % patients received supportive care alone since diagnosis. More than half of elderly AML patients died in acute ward and hematology units (53.5 %), while 30.2 % died in PC settings. Overall, 51.2 % of patients spent the whole period of their final month of life in-hospital. Infection-related diagnoses contributed to 51.2 % of deaths. Median time from AML diagnosis to first PC consultation was 1.0 month. PC service includes psychosocial support (100 %), hospice in-patient care (30.2 %), homecare (60.5 %), PC outpatient clinic (14.0 %) and bereavement care (93.0 %).

Conclusions

Elderly AML patients carry dismal prognosis with their final phase of disease mostly hospitalized in acute care settings. Infections and bleeding could complicate course of illness and lead to rapid deterioration. PC collaboration remains important in psychosocial support and coverage of dying AML patients in non-hospice settings.

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Acknowledgments

The authors acknowledge Professor Albert Lie, Professor Y.L. Kwong and Professor Y.H. Leung, as well as all medical and nursing staff of Hematology Unit, Queen Mary Hospital, University of Hong Kong, for their support and advice on the management of hematology patients under palliative care.

Conflict of interest

None.

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Authors and Affiliations

  1. Palliative Medical Unit, Grantham Hospital, 125 Wong Chuk Hang Road, Aberdeen, Hong Kong, SAR, China

    Hon-Wai Benjamin Cheng, Cho-Wing Li, Kwok-Ying Chan, Pan-Fong Chan, Yim-Ching Sin, Yan Szeto & Mau-Kwong Sham

  2. Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong

    Hon-Wai Benjamin Cheng & Ho-Yan Au

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  1. Hon-Wai Benjamin Cheng
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  2. Cho-Wing Li
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  3. Kwok-Ying Chan
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  6. Yim-Ching Sin
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  7. Yan Szeto
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  8. Mau-Kwong Sham
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Correspondence to Hon-Wai Benjamin Cheng.

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Cheng, HW.B., Li, CW., Chan, KY. et al. End-of-life characteristics and palliative care provision for elderly patients suffering from acute myeloid leukemia. Support Care Cancer 23, 111–116 (2015). https://doi.org/10.1007/s00520-014-2333-x

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  • DOI: https://doi.org/10.1007/s00520-014-2333-x

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