Comparison of End-of-Life Care Between Patients With Hematological Malignancies Versus Solid Tumors: A Retrospective Analysis

Abstract

Background: End-of-life care for cancer patients varies significantly based on the type of malignancy, with hematological malignancies (HMs) and solid tumors (STs) presenting unique challenges. While specialized palliative care (PC) is well-established for managing STs, its integration into HMs’ care remains less common despite evidence of its benefits. Objective: To compare the quality of end-of-life care and PC involvement in patients with HMs versus those with STs using recognized quality indicators. Methods: A retrospective comparative study was conducted at a large tertiary care center in Riyadh, Saudi Arabia, covering the period from January 1, 2023, to December 31, 2023. Data were retrieved from medical records and included demographics, clinical information, and healthcare service use during the last 6 months before death. Results: The cohort consisted of 350 adult patients, of whom 86 (24.6%) had HMs and 264 (75.4%) had STs. Overall, HMs patients received more aggressive end-of-life care, including higher rates of Intensive Care Unit (ICU) admissions (81.4% vs 17.8%), intubation (36% vs 8.3%), disease-modifying treatments (23% vs 3.8%), as well as more enteral feeding, dialysis, blood transfusions, and antimicrobial use. Their resuscitation discussions occurred closer to death (3 vs 16 days; p < .001). Additionally, HMs patients had fewer referrals to PC services (43% vs 79.2%; p < .001), and most of them died in the ICU (59.3% vs 18.2%; p = .0001). Conclusions: These findings highlight the need for further research to understand the unique needs of HMs patients better and to adapt care models that improve their quality of life and end-of-life experience.