Chapter 4 72 ABSTRACT Purpose Patients with haematological malignancies (HM) have more unpredictable disease trajectories compared to patients with advanced solid tumours (ST) and miss opportunities for a palliative care approach. They often undergo intensive diseasedirected treatments until the end of life with frequent emergency department (ED)-visits and in-hospital deaths. Insight into end-of-life trajectories and quality of end-of-life care can support arranging appropriate care according to patients’ wishes. Methods Mortality follow-back study to compare of end-of-life trajectories of HM- and ST-patients who died <3 months after their ED-visit. Five indicators based on Earle et al. for quality of end-of-life care were assessed: intensive anti-cancer treatment <3 months; ED-visits <6 months; in-hospital death; death in the ICU; in-hospice death. Results We included 78 HM-patients and 420 ST-patients, median age 63 years, 35% had ECOG performance status 3-4. At the ED, common symptoms were dyspnoea (22%), pain (18%) and fever (11%). After ED-visit, 91% of HM-patients versus 76% of ST-patients were hospitalized (p=0.001). Median survival was 17 days (95%CI 15-19); 15 days in HM-patients (95%CI 10-20) versus 18 days in ST-patients (95%CI 15-21), p=0.028. Compared to STpatients, HM-patients more often died in-hospital (68% vs 30%, p<0.0001) and in the ICU or ED (30% vs 3%, p<0.0001). Conclusion Because end-of-life care is more aggressive in HM-patients compared to ST-patients, a proactive integrated care approach with early start of palliative care alongside curative care is warranted. Timely discussions with patients and family about advance care planning and end-of-life choices can avoid inappropriate care at the end of life.
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