End-of-Life Discussions With Blood Cancer Patients Occur "Too Late"

Most hematologic oncologists have end-of-life (EOL) discussions with patients with blood cancers too late, according to a new study.

About 56% of hematologic oncologists who answered a survey regarding the timing of EOL discussions stated that they were happening “too late” with their patients, according to a study published by JAMA Internal Medicine.

Scope of the Study

The lead author of the study, Oreofe O. Odejide, MD, of the Dana-Farber Cancer Institute, Boston, studied the timing of EOL discussions with blood cancer patients along with 5 co-authors. They conducted a 4-month postal survey with 349 US hematologists. The participants were identified from the clinical directory of the American Society of Hematology.

The median age of the participants was 52 years, and a majority of them (75%) were males. Out of the hematologists who completed the survey, 43% practiced primarily in tertiary centers and 55% practiced in community centers.

The results showed that 55.9% of the oncologists who treat blood cancer patients had EOL discussions “too late.”

Some specific results were as follows:

• Oncologists in tertiary centers were less likely to begin EOL discussions than those in community centers.
• 42% of the respondents had their first conversation about recovery status at less than optimal times.
• 23% of the respondents had their fist discussion about hospice care with their patients only when death was clearly imminent.

• 40% reported waited until death was clearly imminent before having an initial conversation about the preferred site of death.
• 63% of the respondents reported that they did not feel knowledgeable enough to have EOL discussions with their patients.

Impact of the Study

There may be several reasons for not having the EOL discussions earlier than necessary. While most solid and harmful cancers are incurable when they reach stage IV (advanced stage), many advanced stage hematologic cancers can still be cured. This lack of distinction of which cancer can be cured and which cannot be cured, may delay EOL discussions for many oncologists.

The study also highlights the need for tertiary centers to adopt more dynamic and targeted interventions to improve the quality of their EOL care. This is especially important because tertiary centers often have greater accessibility to EOL resources. They even have academic departments specializing in palliative care. Despite this availability and ready disposal of EOL care, tertiary centers were less likely to initiate conversations with their patients.

Conversations about hospice care include giving patients the options for supportive care during the final phase of their terminal illness. These discussions focus on comfort and ease of life rather than cure. Not having discussions about hospice care and preferred site of death could add tremendously to the overall medical costs. The study highlights the need to address these issues much earlier in the treatment.