Dr El-Jawahri on the Impact of Palliative Care on End-of-Life Care for AML and MDS

Areej El-Jawahri, MD, associate director, Cancer Outcomes Research and Education Program, director, Bone Marrow Transplant Survivorship Program, associate professor, medicine, Massachusetts General Hospital, discusses findings from a multi-site, randomized trial (NCT03310918) investigating a collaborative palliative oncology care model for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) receiving nonintensive therapy at 2 tertiary care academic hospitals.

This study compared the effects of a collaborative palliative and oncology care model on end-of-life care delivery and quality of life (QOL) vs usual care in 115 adult patients with AML and high-risk MDS. Patients who were randomly assigned to the interventional arm met with a palliative care clinician monthly in the outpatient setting and at least twice a week during every hospital admission.

Patients in the study who received the palliative care interventions had a median of 41 days from end-of-life care discussions to death, compared with 1.5 days in the standard care group (P < .001). Additionally, patients who received the palliative care interventions were more likely to articulate their end-of-life care preferences and have these preferences documented in electronic health records, El-Jawahri begins. This documentation correlated with fewer hospitalizations in the final 30 days of life, she notes. Furthermore, palliative care recipients experienced QOL improvements and a trend toward reduced anxiety symptoms vs the patients who received usual care, El-Jawahri says.

These findings underscore the necessity of integrating palliative care as a standard of care for patients with AML and high-risk MDS, El-Jawahri emphasizes. Evidence from multiple clinical trials confirms that palliative care enhances patient outcomes by improving QOL, addressing physical and psychological symptoms, and refining end-of-life care delivery, she explains. The challenge now lies in effectively incorporating palliative care into oncology practices and addressing the limited availability of specialty palliative care clinicians, El-Jawahri reports.

The oncology field needs to identify the components of palliative care that most significantly impact patient outcomes, according to El-Jawahri. By understanding these components, oncology practices can incorporate them into primary care delivery for patients and families, ensuring all patients experience benefit, she concludes.