Home Care of Acute Leukemia Patients: From Active Therapy to End-of-Life and Palliative Care. a Three-Year Experience of a Single Centre

Purpose:

Since July 2012, the Haematological Home Care (HHC) program was activated in our Institution to improve quality of assistance of patients with haematological malignancies, both in the terminal phase of disease and during active chemotherapy.

Methods:

We conducted a retrospective study to describe the 3-year experience of our HHC program; its efficacy was measured for acute leukaemia patients only analysing number of hospitalizations, number of accesses to the Emergency department and place of death. Our study population was also compared with historical data from a small group of 17 patients with acute leukaemia assisted at home, by their general practitioner, in the previous 3 years, when the HHC program was not available.

Results:

The study group consisted of 44 patients, 36 of whom (82%) needed a palliative treatment, while 8 (18%) had an ongoing active chemotherapy. The mean number of hospitalizations was 0.64 (range 0-7) per patient and the number of emergency department visits was 0.82 (range 0-4) per patient. Place of death was home environment in 51.4% and hospital in 40.5% of patients.

When compared to data of the historical group, HCC program significantly reduced the number of hospitalizations (0.64 vs 2.53 per patient, range 0-9; P 0.001), significantly increased the number of patients who died at home (51.5% vs 6%; P=0.003) and reduced those who died in hospital (40.5% vs 65%; P 0.003).

Conclusions:

Home care for patients with acute leukaemia is feasible, decreases the number of hospitalizations, and increases the number of patients who die in their own home.

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