Palliative referral rates low despite burden of leukemia
By Sarah Guy, medwireNews Reporter
20 March 2013
Leuk Res 2013; Advance online publication

medwireNews: The rate of referrals to palliative or supportive care services for patients with acute leukemia is low, despite this population reporting a high burden of physical and psychological symptoms, show Canadian study results.

Over 90% of patients in the study reported experiencing at least five concurrent physical and psychological symptoms, while over half experienced more than 10 such symptoms.

The most common symptoms included a lack of energy, being drowsy, having a dry mouth, and having difficulty sleeping.

"Routine distress screening may help to identify symptoms that are clinically significant and that may benefit from timely referral to specialized psychosocial services," say Camilla Zimmermann (University Health Network, Toronto, Canada) and colleagues who observed that the rate of referral to such services was low even among patients who died.

The study cohort included 249 individuals aged a mean of 50 years, with recently diagnosed or recently relapsed leukemia between January 2008 and February 2012.

Almost all patients (90%) were in hospital when they took part in the study, which involved completing the Karnofsky Performance Status index to measure physical functioning, the Memorial Symptom Assessment Scale (MSAS) to assess symptom burden, and the Global Distress Index (GDI).

Participants reported a mean of nine physical and two psychological symptoms, with 91% reporting more than five concurrent symptoms and 61% reporting more than 10.

Those who reported feeling intense pain (a score of at least 2 on the MSAS) had an approximate threefold increased risk for worrying, having a lack of energy, feeling nauseous, and having mouth sores compared with their counterparts who reported less intense, or no pain.

A total of 14% of patients died within the 6-month follow-up period, with a mean time to death of 3 months, note Zimmermann et al in Leukemia Research. There were no significant differences in GDI scores or physical and psychological subscale scores on the MSAS between patients who died within 6 months of the study and those who did not.

Of those who died, just 6% were referred to palliative care, at a mean 6 days before death, reports the team.

The authors suggest that models of palliative and supportive care designed for this patient population "may be useful to support patients through the symptoms and distress associated with intensive treatment, and potentially to the end of life."

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