Dr Jennifer Vidrine on Compassionate End-of-Life Care for Patients With Hematologic Diseases

Jennifer Vidrine, MBBS, MRCP, a palliative and supportive care consultant at Newcastle upon Tyne Hospitals with a special interest in patients with blood cancers, highlights that end-of-life care for adult patients with hematologic diseases involves managing uncertain prognoses with flexible, holistic care to address symptoms like pain, bleeding, and symptomatic anemia; she notes that providers must ensure that these interventions are beneficial and tailored to each patient.

Vidrine expanded upon this in her presentation, "Adult End of Life Care," during the session, "Perspectives on End of Life Care in Hematology" at the European Hematology Association (EHA) 2024 Congress.

Transcript

What does end-of-life care for patients with hematologic diseases typically entail?

What we know is that patients with blood cancers typically experience an awful lot of uncertainty around their prognosis, around the timeline and the trajectory that their disease is going to take. So, it's really important that palliative and end-of-life care is able to be flexible and agile and meet the needs of the patient in front of them in a way that doesn't require there to be that certainty that these patients typically often don't experience.

It needs to be person centered. It's about managing the whole patient in a holistic way, in terms of their symptom burden, managing things like pain, managing things like treatment toxicities; chemotherapy-induced nausea and vomiting is one example of that. But also acknowledging the significant psychological impact that a blood cancer diagnosis has and how difficult that can be not just for the patient, but also for their loved ones. So, it's about enveloping holistic care that is for the patient and their loved ones, also, and meets the needs of each individual patient.

What are the most common symptoms experienced by patients with hematologic diseases at the end of life? How are they managed?

In some ways, patients towards the end of life with a blood cancer have many of the same symptoms as a patient with a solid organ malignancy; things like pain, sickness, fatigue, shortness of breath.

But there are also some more specific things that I see more in my blood cancer patient population, such as bleeding. It's really important that we think ahead as to the risk of somebody bleeding at end of life, because of low platelets, and think about how we might try and prevent that or manage that if that does come so that it doesn't cause distress for a patient. Things like midazolam can be used as a benzodiazepine to reduce the distress around any significant catastrophic bleeding.

Also, interventions like managing a patient with dark towels, dark bedding, so that the blood isn't quite as obvious. Thankfully, that's a relatively rare occurrence at end of life in patients with blood cancers, but it's important to plan for. Other things that can happen more often in my blood cancer population are infection and the fever that comes with that. We often talk about managing that at end of life with medications but also cool compresses, a fan, an open window, some very simple interventions.

The other is symptomatic anemia, and often patients are blood-product dependent until soon before they die. Often, we continue that perhaps a bit later than we would in patients with solid organ malignancy because we recognize that there is for some patients benefit, but we absolutely must ensure that we don't do that if there isn't a benefit. It mustn't ever be something we do because it's something that we routinely do; be really careful about weighing up the benefits and burdens of any intervention.