Early Palliative Care in Multiple Myeloma Improves Quality of Care, End-of-Life Care

Integrating early palliative care (EPC) into routine treatment for patients with multiple myeloma is beneficial, according to a study published in BMJ Supportive & Palliative Care. 

EPC is proven beneficial for patients with acute myeloid leukemia; however, little is known about whether EPC would benefit patients with multiple myeloma. Therefore, a team of researchers conducted an observational, retrospective study to compare quality indicators for palliative and end-of-life (EOL) care in patients with multiple myeloma receiving EPC with those of patients receiving usual hematologic care (UHC). 

This study used data from 290 consecutive patients with multiple myeloma, with 4 patients excluded because their treatments started at another institution. As part of the study, 55 patients with multiple myeloma received EPC and 232 received UHC. 

In comparing the quality indicators, through a review of electronic hospital charts, the researchers found that patients in the EPC group had a significantly higher number of quality indicators of care compared with the patients in the UHC group (mean 2.62±1.25 vs 1.12±0.95). 

Patients in the EPC group experienced a significant reduction in pain intensity over the time points considered in the study (baseline, week 1, and week 4). Consistent with this observation, 40 (72.7%) patients in the EPC group received strong opioids as part of their treatment, compared with 129 (55.8%) patients in the UHC group. 

Of the 115 deaths, 22 were in the EPC group and 93 were in the UHC group. Patients in the EPC group were less likely to receive aggressive treatment in the end-of-life period than were the patients in the UHC group, but the difference was not statistically significant. 

Additionally, patients in the EPC group received a lower mean number of treatment lines than did those in the UHC group (1.53±0.77 vs 1.90±1.21). Median overall survival was 5.30 years in the EPC group and 5.46 years in the UHC group (adjusted hazard ratio, 0.92; 95% CI, 0.56 to 1.51; P =.7429). 

Ultimately, patients receiving EPC experienced better pain control with longer use of strong opioids, higher rates of symptom management, and a trend toward higher quality EOL care, among other benefits. 

Although this study is one of the most comprehensive studies of its kind, the researchers acknowledged some limitations. The retrospective nature of the data and its single-center status could limit the generalizability of these results to other centers that may not have trained supportive and palliative care teams. 

“In conclusion, our results suggest that EPC is feasible in patients with MM and results in better quality of care, including better management of pain, more psychological support, more frequent [goals of care] and [advance care plans] discussions, and a trend to reduced aggressiveness at the EOL, without negatively impacting survival,” the researchers wrote. 

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 

Reference

Giusti D, Colaci E, Pioli V, et al. Early palliative care versus usual haematological care in multiple myeloma: retrospective cohort study. BMJ Support Palliat Care. Published online September 26, 2023. doi:10.1136/spcare-2023-004524