Hematologic malignancies are a heterogeneous group of diseases with unique illness trajectories, treatment paradigms, and potential for curability, which affect patients' palliative and end-of-life care needs. Patients with hematologic malignancies endure immense physical and psychological symptoms because of both their illness and often intensive treatments that result in significant toxicities and adverse effects. Compared with patients with solid tumors, those with hematologic malignancies also experience high rates of hospitalizations, intensive care unit admissions, and in-hospital deaths and low rates of referral to hospice as well as shorter hospice length of stay. In addition, patients with hematologic malignancies harbor substantial misperceptions about treatment risks and benefits and frequently overestimate their prognosis. Even survivors of hematologic malignancies struggle with late effects, post-treatment complications, and post-traumatic stress symptoms that can significantly diminish their quality of life. Despite these substantial unmet needs, specialty palliative care services are infrequently consulted for the care of patients with hematologic malignancies. Several illness-specific, cultural, and system-based barriers to palliative care integration and optimal end-of-life care exist in this population. However, recent evidence has demonstrated the feasibility, acceptability, and efficacy of integrating palliative care to improve the quality of life and care of patients with hematologic malignancies and their caregivers. More research is needed to develop and test population-specific palliative and supportive care interventions to ensure generalizability and to define a sustainable clinical delivery model. Future work also should focus on identifying moderators and mediators of the effect of integrated palliative care models on patient-reported outcomes and on developing less resource-intensive integrated care models to address the diverse needs of this population.

中文翻译：

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血液系统恶性肿瘤患者的姑息治疗和临终关怀

血液恶性肿瘤是一组异质性疾病，具有独特的疾病轨迹、治疗模式和治愈潜力，影响患者的姑息治疗和临终关怀需求。血液恶性肿瘤患者由于疾病和经常导致显着毒性和不良反应的强化治疗而承受巨大的身体和心理症状。与实体瘤患者相比，血液系统恶性肿瘤患者的住院率、重症监护室入院率和院内死亡率也较高，转诊至临终关怀机构的比例较低，且临终关怀机构的住院时间较短。此外，血液系统恶性肿瘤患者对治疗风险和获益存在严重误解，并经常高估其预后。即使是血液系统恶性肿瘤的幸存者也会与晚期效应、治疗后并发症和创伤后应激症状作斗争，这些症状会显着降低他们的生活质量。尽管存在大量未满足的需求，但很少有人咨询专业姑息治疗服务来治疗血液恶性肿瘤患者。该人群中存在一些特定疾病、文化和系统障碍，阻碍姑息治疗整合和最佳临终关怀。然而，最近的证据证明了整合姑息治疗以改善血液恶性肿瘤患者及其护理人员的生活质量和护理的可行性、可接受性和有效性。需要更多的研究来开发和测试特定人群的姑息和支持性护理干预措施，以确保普遍性并定义可持续的临床交付模式。未来的工作还应侧重于确定综合姑息治疗模式对患者报告结果影响的调节因素和中介因素，并开发资源密集程度较低的综合护理模式来满足该人群的多样化需求。