hematologic malignancies : a review

Although home care (HC) of cancer patients is a common practice, so far only limited efforts have been made to define its role in the global management of patients suffering from malignant blood disorders, who are mainly treated in hospital or in outpatient clinics. HC has not been intensively applied in the treatment of these malignancies, this approach having been traditionally reserved for the final management of a minority of terminally ill patients; moreover the organization of HC has often relied on volunteers, so that the place of death remained almost exclusively the hospital ward, in a setting focused on curing acute illness and prolonging life, rather than relieving suffering. Nevertheless, as the costs of acute care in hospitals are increasing and attention to quality of life (QoL) is growing, some efforts have been made to find alternative models to assist chronically and terminally ill patients. Moreover, the need to save costs, together with a more rational use of high-technology hospital resources, has led to the development of supervised care plans, based on integrated strategies that move from the traditional inpatient care to the HC setting, even for high risk patients such as those undergoing intensive chemotherapy and/or hematopoietic stem cell transplantation (HSCT). On this background, hematology HC services can play an important role, establishing specific care systems and decision-making which should be adopted for particular categories of patients (Table 1), defined by the phase of specific diseases and by the patient’s life expectancy. This article attempts to review the published studies on this topic to summarize the current use of HC and to address some points of potential development for this model of care in the setting of blood-related malignancies.