Patienten mit fortgeschrittenen hämatologischen Grunderkrankungen in der Spezialisierten Ambulanten Palliativversorgung (SAPV)

by Lea Magdalena von Rudloff
Doctoral thesis
Date of Examination:2025-03-27
Date of issue:2025-01-17
Advisor:Prof. Dr. Bernd Alt-Epping
Referee:PD Dr. Johannes Hauswaldt
Referee:PD Dr. Friederike Braulke
Persistent Address: http://dx.doi.org/10.53846/goediss-10999

 

 

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Abstract

English

Patients with advanced haematological malignancies in non-curative settings suffer from complex physical symptoms and psychosocial distress, comparable to patients with solid tumour entities. Nevertheless, numerous problems at the interface between haematology and palliative home care have been described. From January 2011 until October 2014, we performed a retrospective, multicenter analysis of all patients with haematological malignancies (ICD 10: C81-C95) being treated by the respective specialized palliative home care (SAPV) team. Three SAPV teams were surveyed. Disease entity, physical symptoms, psychosocial distress, number of hospital admissions, therapeutic interventions and other items were analysed descriptively. Of 3,955 SAPV patients, 1.8% (n = 73) suffered from haematological malignancies. Main problems were deterioration of general condition, pain or psychological problems. Thirty-seven percent developed new symptoms during SAPV, mainly pain, psychological distress or deterioration of general status. In 33%, patients were referred to hospital, mainly due to deterioration of general condition or pain. Seventy percent died within 3 months after beginning SAPV care; 83% died at home or in a nursing home. Patients suffering from advanced haematological malignancies were statistically underrepresented in SAPV, and SAPV was installed rather at the very last days of life. By far, more patients were able to die outside a hospital as compared to reference cohorts of haematological patients not being treated in SAPV. The spectrum of documented problems is comparable to other patient cohorts being treated in SAPV; therefore, the options and benefits of palliative home care should be incorporated in palliative haematological treatment concepts more vigorously and consequently.
Keywords: Specialized palliative home care; Haematological malignancies; Physical symptoms; Psychosocial distress
 
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