Clinical Indicators That Identify Risk of Deteriorating and Dying in People with a Hematological Malignancy: A Case-Control Study with Multivariable Analysis

Elise Button, Nicole C. Gavin, Raymond J. Chan, Shirley Chambers, Jason Butler, Patsy Yates

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: Identifying people who are at risk of deteriorating and dying is essential to inform goals of care, appropriate treatment decisions, patient autonomy, and effective end-of-life care. Limited literature exists on predicting survival near the end of life for people with a hematological malignancy. Objective: To identify the key clinical indicators that signal a person with a hematological malignancy is at high risk of deteriorating and dying. Design, Setting, Participants: Eleven clinical indicators identified in a Delphi approach were tested via a retrospective case-control study. Each indicator was assessed for at each in-patient admission between living (n = 236) and deceased (n = 120) people with a hematological malignancy who were admitted to a large tertiary hospital between 1st July 2014 and 31st December 2015. Results: Six clinical indicators were independently associated with mortality in the final three months of life: declining performance status (Odds Ratio [OR] 7.153, 95% Confidence Intervals [CI] 3.281-15.597, p = < 0.001); treatment limitations of the hematological malignancy (OR 7.855, 95% CI 3.528-17.489, p = < 0.001); relapse, refractory or persistent disease (OR 3.749, 95% CI 1.749-8.039, p = 0.001); presence of two or more comorbidities (OR 2.991, 95% CI 1.319-6.781, p = 0.009); invasive fungal infections (OR 4.887, 95% CI 1.197-19.949, p = 0.027); and persistent infections (OR 6.072, 95% CI 2.551-14.457, p = < 0.001). Conclusions: This study has identified six clinical indicators that signal a person with a hematological malignancy is at high risk of deteriorating and dying and may benefit from an assessment of palliative needs and proactive planning, along-side appropriate treatment.

Original languageEnglish
Pages (from-to)1729-1740
Number of pages12
JournalJournal of Palliative Medicine
Volume21
Issue number12
DOIs
Publication statusPublished - Dec 2018
Externally publishedYes

Keywords

  • case-control
  • clinical indicators
  • deteriorating and dying
  • end-of-life care
  • hematologic neoplasms
  • predicting survival

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