Differences in Perspectives and Policies Regarding End-of-Life Care Between Hematologists and Gastroenterologists

Patients with hematologic malignancies often receive aggressive treatment until the terminal phase and transition to end-of-life (EOL) care less frequently than those with solid tumors. A 2015 survey compared hematologists' and solid tumor-oncologists' attitudes toward EOL care, revealing differences. A decade later, no similar reports have appeared despite therapeutic advances. Therefore, we repeated the survey with additional questions to examine whether perspectives on EOL care have changed.

A 50-item questionnaire was administered to hematologists and gastroenterologists. Responses came from 121 hematologists treating hematologic cancers, 141 gastroenterologists treating gastrointestinal cancer including eight medical oncologists managing both. For analysis, hematologists were compared with 141 gastroenterologists.

In both groups, refractory to standard therapy for cancer was the leading reason for initiating EOL care, with no significant differences. However, hematologists were less likely to transition ≥ 21% of patients to EOL care (p < 0.0001), more likely to register relapsed or refractory patients in clinical trials (p < 0.0001), to administer therapy to patients with 1-month expected survival and Eastern Cooperative Oncology Group performance status of 4 (p < 0.0001), and to cite barriers such as limited transfusions and restrictions on referrals to palliative care wards (p < 0.0001).

Hematologists' continuation of therapy in terminal patients and difficulty referring to palliative wards persisted since 2015, indicating unchanged attitudes. Additional findings confirmed reliance on clinical trials, and emphasis on transfusions, which may hinder timely EOL transitions in hematologic malignancies.