COMMENTARY

Do We Know What Matters Most to Cancer Patients?

Betty R. Ferrell, PhD, RN

Disclosures

February 24, 2017

What Matters to Cancer Patients in Palliative Care

Efforts to define and measure outcomes that recognize quality palliative care across diseases have been significant. In the field of oncology, greater emphasis has been placed on patients with solid tumors, with less evidence available about those with hematologic malignancies.

A recent article[1] reported on adherence with the American Academy of Hospice and Palliative Medicine's "Measuring What Matters" priorities by palliative care clinicians caring for both cancer groups. An audit of care of 678 patients' first visits revealed that both solid tumor and hematologic patient groups were similar in measures of pain treatment, spiritual concerns, treatment preferences, and care consistent with preferences.

Clinicians caring for hematology patients were significantly less likely to meet the measures related to screening for physical symptoms and discussion of emotional needs.

Viewpoint

Recognition has grown that, given the nature of the disease and treatment, patients with hematologic malignancies have unique support needs.[2,3,4] This study further contributes to the literature by documenting that when "Measuring What Matters," this group of patients received lower quality of care in two important dimensions—screening for physical symptoms and discussing emotional needs.

Previous studies have documented that patients with hematologic disease are less likely to be referred to a palliative care service.[5] There is also general consensus that these patients more often die in intensive care settings, that they are difficult in terms of prognostication, and that both clinicians and families struggle with goals of care and the possibility of care despite declining status.

The two areas of lower quality in the hematologic patients (symptom management and emotional support) are critical areas in the care of these patients. The nature of hematologic cancer treatment results in many symptoms associated with great distress. This is often a younger population, and it is a disease with high uncertainty and rigorous treatment plans including stem cell treatment and aggressive chemotherapy, all of which signal a strong need for emotional support.

The "Measuring What Matters" campaign has gained recognition for emphasizing the aspects of quality that really matter to patients facing serious illness. In this important study, LeBlanc and colleagues have made an even greater contribution by identifying important differences within the oncology patient population, finding that those with hematologic diseases need attention to the concerns that matter most to them.

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