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Treatment ethics, quality of life and health economics in the management of hematopoietic malignancies in older patients

Bone Marrow Transplantation volume 50, pages 1145–1149 (2015)Cite this article

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Abstract

The prevalence of diseases such as AML or myelodysplastic syndromes increases with the aging of the population. Only intensive chemotherapy or hematopoietic cell transplantation have curative potential. However, comorbid conditions may interfere with effective therapy. Although transplantation following low-intensity conditioning is being carried out in patients even in their 70s, these are highly selected patients, and the data cannot be extrapolated to the population at large. Further, such a therapy in older individuals may be associated with considerable morbidity and the need for prolonged hospitalization and rehabilitation, stressing the system and draining family resources. As the focus of many older individuals is on quality of life, it is important to emphasize that, for various advanced malignancies, emerging data indicate that quality of life may be better and survival may be longer with palliative care. A re-assessment of treatment decisions in older patients is in order. We tend to 'oversell', and particularly older patients do not have a full understanding of the impact of the proposed therapy on their lives. Our conversations with these patients must include a discussion of supportive/palliative care and must address end-of-life issues. Talking about death may mean talking about life.

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Acknowledgements

I would like to thank my colleagues at the Fred Hutchinson Cancer Research Center and at several centers in France, which I visited during a recent sabbatical, for their comments. I would like to thank in particular Drs Scott Ramsey, Tony Back, Karen Syrjala, Nandita Khera, Robert Zittoun, Jean-Francois Schved, Mohamad Mohty, Jean-Luc Harousseau, Pierre Fenaux, Lionel Ades, Elie Azoulaye, Gerard Socie, Mike Mullarkey, Fred Tubridy and Jim Miller. I appreciate the help of Helen Crawford and Bonnie Larson with manuscript preparation This study was supported by the National Cancer Institute, National Institutes of Health, Bethesda, MD (CA018029, CA015704, CA078902).

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    H J Deeg

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Deeg, H. Treatment ethics, quality of life and health economics in the management of hematopoietic malignancies in older patients. Bone Marrow Transplant 50, 1145–1149 (2015). https://doi.org/10.1038/bmt.2015.130

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