Table 1 shows the demographic characteristics of the 53 patients with haematologic malignancies (men, 40; women, 13; mean age, 76.7 years; age range 69–83 years) who received hospice care. Lymphoma was predominant among these patients, followed by leukaemia, multiple myeloma and myeloproliferative disorder/myelodysplastic syndrome. Of the 53 patients, 32 (60.4%) died within 24 hours after their first palliative consultation.
Table 2 shows the characteristics of 23 patients in the first group (men, 17; women, 6; mean age, 76.7 years; age range 57–93 years) who received hospice care before the integration of the PPI score. During this period, 564 patients with terminal solid tumours received hospice care at our hospital. Lymphoma was predominant among these patients, followed by leukaemia (including acute myeloid leukaemia and acute lymphoblastic lymphoma), multiple myeloma and myeloproliferative disorder/myelodysplastic syndrome. Of the 23 patients, 10 (43.7%) died within 24 hours after their first consultation. After applying the PPI score, 30 patients with haematologic malignancies (23 male) received hospice care. During the same period, there was an increase in the number of patients with terminal solid tumours who received hospice care consultation (771 patients). The mean age of these patients was 74 years (range, 25–95 years), and the main type of cancer in this group was leukaemia. The number of deaths within 24 hours declined (8 of 30 patients, 26.67%). After the PPI was implemented, we observed several interesting results. Although there was no apparent difference between the two groups in terms of the distribution of the PPI score, the type of cancer diagnosed did change significantly (p = 0.03), with leukaemia becoming the predominant type of cancer. The number of patients who expired within 24 hours also notably decreased (p = 0.04). With regard to treatment modality, only the frequency of antibiotic use showed a significant decrease (86.96–56.67%, p = 0.03). Compared with the first period, the proportion of patients receiving hospice care at the first palliative consultation did not increase in the second group.
After 2 years of follow-up, we assessed whether the life expectancy of patients with haematologic malignancies after the first palliative consultation was associated with the PPI score. Figure 1a shows that the median overall survival in patients with a PPI score > 6 and ≤6 was 23.1 ± 7.6 days and 269.3 ± 118.2 days, respectively. The clinical impact of the PPI intervention on survival is shown in Fig. 1b. Before the PPI score was used, the median overall survival was only 12.0 ± 12.3 days. After we started our programme, the median survival time was 131.4 ± 55.9 days, which was significantly longer (p < 0.01).
Table 3 shows the impact of the PPI score on patient care. Although more leukaemia patients were included after the PPI intervention, the distribution of PPI score (> 6 or ≤ 6) also showed no difference. Patients with a PPI score greater than 6 required more support, especially in terms of blood transfusion (54.72%, p = 0.05), antibiotic use (58.49%, p = 0.02), and oxygen supplementation (73.58%, p < 0.01). The number of deaths within 24 hours after the first consultation and the patient or family’s agreement to hospice care were also significantly associated with a PPI score > 6 (p < 0.01 and 0.02, respectively).
Next, we enrolled disease type, age > 65 years, gender, PPI score > 6 and aggressive interventions, including blood transfusion, antibiotic use, oxygen supplementation and pain control, as prognostic factors in the univariate and multivariate analyses. Both antibiotic use and PPI score > 6 were independent factors of overall survival. The group with a PPI score > 6 showed an increased risk of death (hazard ratio [HR] [95% confidence interval {CI}] 2.82 [1.32–6.03], p = 0.01). Antibiotic use did not improve the patient’s outcome instead of increasing the risk of death (HR [95% CI)] 3.68 [1.64–8.29], p < 0.01).