Acute Myeloid Leukemia: Challenges in Delivering End-of-Life Care

Patients with Acute Myeloid Leukemia (AML) have a complex disease trajectory characterized by high symptom and psychosocial burden, a high rate of hospitalization and intensive care unit admission at the end-of-life (EOL), and frequent use of chemotherapy near the EOL. In addition, palliative and hospice care are underutilized in patients with AML despite their poor prognosis. Clinicians providing care to patients with end-stage AML frequently encounter multiple challenges, particularly surrounding the frequent administration of blood products near the EOL. We present a case of a patient with end-stage AML whose desire for transfusions causes significant patient and caregiver distress at the EOL. Balancing patient autonomy with the potentially inappropriate use of blood transfusions at the EOL and having good communication and collaboration among healthcare teams are important considerations when delivering optimal EOL care to patients with AML.