Care of the Imminently Dying Patient with a Hematologic Malignancy or Serious Blood Disorder

Patients with a hematologic malignancy or serious blood disorder represent a unique set of patients. The chronicity of these types of medical conditions cloud the ability to distinguish accurately a malignancy that may respond to other lines of therapy from those where disease-directed therapy is not curative in nature. Where the beginning of the end-of-life phase begins for patients with a hematologic malignancy is murky, and as a result, the last month of their lives is markedly different compared to patients with solid tumors. Patients with a hematologic malignancy or serious blood disorder are more likely to receive chemotherapy, visit the emergency department, and be admitted to an intensive care unit and less likely to see a palliative care specialist or enroll in hospice in the last month of their life. These make their end-of-life care different than those patients with solid tumors, and they are at a high risk for the development of distressing physical, psychosocial, and spiritual symptoms at the end of life. The benefits of well-timed delivery of specialized palliative care are associated with improved outcomes of quality-of-life measures, increased enrollment in hospice, and decreased use of non-beneficial life-prolonging interventions. This chapter aims to provide a comprehensive, evidence-based, and interdisciplinary approach to care of the imminently dying patient with a hematologic malignancy or serious blood disorder.