Malignant Hematologic Oncology Referrals to an Outpatient Palliative Care Clinic at a Tertiary Cancer Center.

Abstract

Context: Hematological malignancies represent a heterogeneous group of diseases with variable and often unpredictable illness trajectories. Comparisons between hematological and solid tumor malignancy referrals to an outpatient palliative care clinic have not been explored.

Objectives: This study compared characteristics, referral trends, and time from first palliative care clinic visit to death between patients with hematological and solid tumor malignancies.

Methods: A retrospective review of palliative care clinic referrals at a tertiary cancer center from January 1st, 2018 to December 31st, 2022 was conducted. Clinical and demographic data, symptom burden, performance status, and time from first palliative care clinic visit to death were compared.

Results: Of 5230 outpatients, 283 (5.4%) had a hematological malignancy (107 [38%] leukemia, 98 [35%] lymphoma, and 78 [28%] multiple myeloma). Patients with leukemia and lymphoma had similar symptom burden to solid tumor malignancies; patients with multiple myeloma had significantly more pain (P < 0.0001) and constipation (P = 0.005). Patients with hematological malignancies had worse performance status compared with solid tumor malignancies (ECOG ≥3 for 37.9% leukemia, 35.0% lymphoma, and 31.6% multiple myeloma vs. 19.6% solid tumor malignancies, P < 0.0001). At 12-months from first palliative care clinic visit, survival probabilities were 27.6% for leukemia, 42.2% lymphoma, and 69.5% multiple myeloma vs. 39.5% solid tumor malignancies.

Conclusion: Patients with hematological malignancies experience at least similar symptom burden to those with solid tumor malignancies referred to a palliative care clinic, and worse performance status, factors that should be considered when designing palliative care clinic interventions for patients with hematological malignancies.