End of life care in hematology: still a challenging concern

The majority of patients with hematological malignancies (HM) may experience troublesome symptoms and complicating clinical syndromes throughout all phases of disease. Therefore, among the current concepts concerning the comprehensive management of HM patients, palliative care should exert a more ever expanding role (1), in particular in the advanced phases of disease. Indeed, the most important aspect of caring for these suffering patients is to ameliorate or restore their quality of life (QoL) though a highly humanized approach, whereas technological and pharmacological measures should be limited enough to control the symptoms burden and the several kinds of sufferance that may complicate the final phase of disease course. However, despite the important implications in terms of allocation of medical resources, the effectiveness of care as well as the choice of most appropriate place of the last care and demise for suffering patients to be close to the death, the management of HM patients in the last week of life has been addressed by very few specific studies (2-4). In the light of these premises, the recently published paper by Cheng and colleagues, dealing with a retrospective analysis on the level of medical care provided in hospice to 25 HM patients during the final week of their life (5), represents an important contribution on this topic. The authors reported that during the last week of life, 85.7% of patients had blood sampling whereas 14.3% of them were on total parenteral nutrition. Given the reduced blood counts, 23.8% of patients received granulocyte colony-stimulating factor (G-CSF) for neutropenia, whereas ？one-third of them received transfusion of red blood cell (RBC) units and nearly half of them received platelet concentrates. In addition, almost 90% of patients received antibiotics. An important and valuable finding outlined by the authors is represented by the good and fruitful collaboration between hematology and palliative care, which, in their experience, allowed for a successful transition of hematologic cancer patients into hospice unit in their terminal phase of illness. Despite this promising and significant finding, however, the level of medical care, during the last week of life of their patients was too intensive, for which the authors claimed the need of future and collaborative researches in order to set a proper allocation of medical resources and the optimal end-of-life care in the hematologic setting (5)