Home Care in Oncohematological Patients Not Candidates for Intensive Chemotherapy: From Active Treatment to the End of Life. Ambispective Multicentric Study on Dual and Early Assessment of Palliative Care and Hematology in a Rural Environment

INTRODUCTION: Elderly patients diagnosed with hematological malignancies are particularly fragile not only because of the prognosis (often disastrous), but also because of the toxicity of existing treatments and comorbidities, to which must be added the isolation of rural populations. All this sum has a notable impact on their quality of life. As of 01-2018, thanks to the conjunction of the Hematology and Palliative Care Services, the first rural Hematopalliative Unit in Spain was implemented, deserving of multiple recognitions.

OBJECTIVE: To analyze whether the dual and early evaluation by the Hematology and Palliative Home Care Services (through our pioneering unit) has a positive impact on quality of life (assessed through the reduction of hospitalizations and compliance with the last wishes) in oncohematological patients who are not candidates for aggressive antineoplastic treatment in rural areas.

METHODOLOGY: Multicenter, analytical and ambispective study that includes 87 patients from 01-2018 to 04-2023 in rural hospitals in Castilla-La Mancha diagnosed with hematological malignancies not candidates for intensive antineoplastic treatment (regardless or not of receiving antineoplastic treatment adjusted to comorbidities or only palliative measures) who received early dual assessment by Hematology and Palliative Care from diagnosis versus usual clinical practice (referral to Palliative Care at the discretion of the hematological physician). Clinical, analytical and social health data were collected.

RESULTS: The median age was 82 years with a predominance of female sex (53%) and 43% of frail patients (ECOG: 2 points or higher). The median distance between home and the hospital was 22 km (range: 1-67 km). Non-Hodgkin Lymphoma (NHL) was the most common neoplasm in the sample (30%), followed by Acute Myeloblastic Leukemia (AML: 20%), myelodysplastic neoplasms (18.5%) and myeloma (17%). 71% of the sample has been assessed dually and early by the Hematology-Palliative services and, if stratified by frailty, statistically significant differences are evident by age (p=0.030), sex (p=0.001). , assessment for palliative care (p=<0.001), receiving/requesting aid covered by the Dependency Law (p=<0.001), administration of antineoplastic treatment (p=<0.001) and reduction in hospital admission (p=0.017). The low percentage of deaths at home stands out (despite the patients' prior wishes) in patients who did not receive dual and early assessment between both services (17% compared to 46%, p=0.034).

CONCLUSION: The dual and early assessment between Hematology-Palliative services in fragile patients has shown in a statistically significant way a decrease in hospital admission, greater accessibility to benefiting from socio-health help and a greater possibility of a dignified death at home following the patients' wishes, consolidating itself as a valid strategy in areas of great geographical dispersion.