Clinical Pearls

Palliative Care in Hematologic Malignancies: Focus on Needs, Not Prognosis

Eric Roeland, MD FAAHPM; Thomas LeBlanc, MD MA

Despite the many advances made in modern oncology, prognostication remains more art than science. Nowhere is this more evident than in the hematologic malignancies. This group of diseases is remarkably heterogeneous and includes leukemias, lymphomas, myeloproliferative neoplasms, and myelodysplastic syndromes, among others. Similarly heterogeneous is their impact on patients, ranging from indolent conditions like low-grade lymphomas, to the more rapidly progressive such as acute leukemias.

Several studies show that patients with hematologic malignancies are less likely to receive palliative care (PC) compared to those with solid tumors. Yet data show that hematologic malignancy patients have an equivalent or higher symptom burden and a higher likelihood of spending time in an ICU, receiving chemotherapy at end of life, or dying in the hospital compared to solid tumor patients.^1-4 There are several reasons for this disconnect, but in short, the refrain we hear from blood cancer specialists is that hematologic malignancies are “just different.” To be successful in better serving this patient population, PC clinicians must better understand what our blood cancer colleagues mean by this.