Early Palliative Care in Advanced Hematologic Malignancies: A Systematic Review of Patient-Centered Outcomes

TL;DR

Early palliative care in advanced blood cancers improves symptoms and quality of life, reduces hospital use, and shifts end-of-life care to home or hospice.

Contribution

This systematic review provides evidence that early palliative care in hematologic malignancies reduces healthcare costs and improves patient-centered outcomes.

Findings

Early palliative care improves symptoms like pain and appetite in advanced hematologic malignancies.

Patients receiving early palliative care are more likely to die at home or hospice rather than in the hospital.

Early palliative care reduces healthcare utilization, including hospitalizations and aggressive end-of-life treatments.

Abstract

What are the main findings?
Early palliative care in hematologic malignancies improves symptoms and quality of life, while reducing hospitalizations, transfusions, and chemotherapy near the end-of-life.Early referral is associated with lower healthcare costs and a shift in the place of death from hospital to home or hospice.

Early palliative care in hematologic malignancies improves symptoms and quality of life, while reducing hospitalizations, transfusions, and chemotherapy near the end-of-life.

Early referral is associated with lower healthcare costs and a shift in the place of death from hospital to home or hospice.

What is the implication of the main finding?
These results support integrating early palliative care into standard hematology practice.Wider implementation could improve patient outcomes, reduce burdensome treatments, and optimize healthcare resource use.

These results support integrating early palliative care into standard hematology practice.

Wider implementation could improve patient outcomes, reduce burdensome treatments, and optimize healthcare resource use.

Background: Patients with hematologic malignancy (HM) experience high symptom burden (SB) and diminished quality of life (QOL). While early palliative care (EPC) benefits solid tumors, its impact in HM remains uncertain. Objectives: To systematically review the effects of EPC on patient-centered outcomes in individuals with HM. Methods: MEDLINE, Web of Science, Cochrane Library, and Scopus were searched for English-language articles published between 2020 and 2024. Eligible studies included adults with advanced HM receiving EPC compared with usual care, reporting outcomes on SB, QOL, place of death (POD), healthcare costs (HCCs), or healthcare utilization (HCU). All original study designs were considered. Critical appraisal was performed, and results were synthesized narratively. The review was registered in PROSPERO (CRD420251019687). Results: Twelve studies were included, most of high quality (n = 10) and mainly conducted in America and Europe. Collectively, they enrolled 42,053 participants, largely with advanced disease, poor performance status, or limited prognosis. EPC consistently improved SB, particularly pain, appetite, and functional well-being, although results for anxiety and depression were inconsistent. Findings for QOL were mixed. EPC was associated with higher likelihood of home or hospice death. One study demonstrated substantial cost savings with home-based EPC. Across several studies, EPC was linked to lower HCU, including fewer transfusions, reduced chemotherapy near the end-of-life, and fewer aggressive interventions, hospitalizations, and intensive care admissions. Conclusions: EPC improves SB, influences POD, and reduces HCCs and HCU in HM. Evidence for QOL and psychological outcomes remains inconclusive. Further high-quality research is required to consolidate these findings.

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