Dr Adam Olszewski Outlines Challenges With Incorporating Palliative Care Earlier in Hematologic Malignancies

Patients with hematologic malignancies receive less appropriate end-of-life care than patients with solid tumors because of barriers with patients, physicians, and the healthcare system in general, said Adam Olszewski, MD, associate professor of medicine at The Warren Alpert Medical School of Brown University.

Transcript

Why is palliative care not used earlier for patients with hematologic malignancies?

So, this is a very interesting and complex and heavily researched issue, actually. There are many studies showing that patients with hematologic malignancies receive less end-of-life, less appropriate end-of-life care. So, they are receiving much more aggressive end-of-life care. And it is very easy to theorize about this how this is happening that, you know, patients with blood cancers have that are often hanging in this state where further treatment is always possible and remission is always possible. And that makes it very difficult for patients and for clinicians to actually recognize the moment where palliative care should come into to help manage patients symptoms and maybe start thinking about really what are further goals of care and what the patient is expecting in terms of their realistic life expectancy.

A lot of research is showing that both clinicians have difficulty with this, and patients may have difficulty with this, as well. There's some prognostic discordance between patients and clinicians when discussing the prognosis of patients with leukemias and lymphomas, and myelomas as well. And then clinicians often have that perception that private care was developed for management of solid tumors, and that the needs of blood cancer patients may not be met fully with what has been developed. I feel that's palliative care physicians are actually quite prepared to manage blood cancer patients although they also need additional training because approaching a patient, you know a young person with multiple relapsed lymphoma or leukemia is quite different from often older patients with solid tumor that progressed as many lines of chemotherapy.

So, I think there are barriers on the on the clinician side, on the on the patient side, and there also some systemic barriers. The study it was shown, during this there's ASH demonstrated that only very, very small number of patients actually billed palliative care services early during the course of their disease—at least 30 days prior to their death. This was barely 2% even though it is increasing in the in recent years.

But the difficulty that arises is also realization that the way we are billing and documenting these services is actually very difficult to capture later on through health services research. And that actually reflects challenges with billing and arranging and putting on this layer of palliative care over the layer of standard clinical care, which is still not fully recognized by insurers and organizations. So, I think there's also some systemic barriers that has to be overcome in integrating this truly.