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

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  • Author(s): Deeg HJ;Deeg HJ
  • Source:
    Bone marrow transplantation [Bone Marrow Transplant] 2015 Sep; Vol. 50 (9), pp. 1145-9. Date of Electronic Publication: 2015 Jun 08.
  • Publication Type:
    Journal Article; Research Support, N.I.H., Extramural; Review
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Nature Publishing Group Country of Publication: England NLM ID: 8702459 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1476-5365 (Electronic) Linking ISSN: 02683369 NLM ISO Abbreviation: Bone Marrow Transplant Subsets: MEDLINE
    • Publication Information:
      Publication: <2003->: London : Nature Publishing Group
      Original Publication: Basingstoke, Hampshire : Scientific & Medical Division, Macmillan Press, c1986-
    • Subject Terms:
      Bioethical Issues* ; Health Services for the Aged*/economics ; Health Services for the Aged*/ethics ; Quality of Life*; Hematologic Neoplasms/*economics ; Hematologic Neoplasms/*therapy; Aged ; Aged, 80 and over ; Female ; Humans ; Male
    • 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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    • Grant Information:
      CA015704 United States CA NCI NIH HHS; CA078902 United States CA NCI NIH HHS; P01 CA018029 United States CA NCI NIH HHS; CA018029 United States CA NCI NIH HHS; P01 CA078902 United States CA NCI NIH HHS
    • Publication Date:
      Date Created: 20150609 Date Completed: 20160527 Latest Revision: 20181113
    • Publication Date:
      20250114
    • Accession Number:
      10.1038/bmt.2015.130
    • Accession Number:
      26052908