End-of-Life Therapeutic Burden: A Comparative Study of Hematologic and Solid Tumor Malignancies

Background During the past years substantial progress has been made in the treatment of hematologic malignancies. However, the majority of patients who suffer from a hematologic malignancy live with incurable and symptomatic diseases and eventually die. Therefore, the palliative services have a major role in the treatment of hematological patients.

Objectives Previous studies have indicated that hematological malignancy (HM) patients receive more aggressive interventions at the end of life, however little is known about the setting in which these aggressive treatments occurred.

Setting/Subjects In order to shed light on this important subject, we collected data for 200 consecutive patients, 100 solid tumor patients and 100 HM patients treated at a single center in Israel who died over the period from June 1st 2016 to June 1st 2020.

Measurements We compared cause of death and end-of-life quality indicators between two groups.

Results HM patients more commonly died from treatment complications in comparison with solid tumor patients (15% vs 1%) and unrelated causes (26% vs 2%, p=0.001). HM patients died more frequently in ICU (14% vs 7%) and the emergency department (9% vs 0%) and less frequently in hospice (9% vs 15%, p=0.005). More HM patients received mechanical ventilation (14% vs 4%, p=0.013), blood units (47% vs 27%, p=0.003) and platelet transfusions (32% vs 7%, p<0.001).

Conclusion These findings strengthen the existing literature showing more aggressive treatment at end-of-life in HM patients which might be affected by the higher rate of treatment related mortality and prognostic uncertainty in this population.

Nachmias:AbbVie: Consultancy, Honoraria.