Thomas William LeBlanc

Background: Myelofibrosis (MF) is a rare myeloproliferative neoplasm characterized by bone marrow fibrosis, anemia, splenomegaly, and debilitating symptoms. Anemia, present in approximately 35% of patients at diagnosis, often worsens over time and is associated with poor quality of life and worsened survival outcomes. Red blood cell transfusions help to manage anemia but are burdensome and may lead to iron overload. Existing literature focuses on clinical outcomes, and little is known about patient-perceived and -experienced impacts of transfusion and anemia. Methods: This mixed-methods study across 6 countries included qualitative interviews and an online survey of symptomatic (Myelofibrosis Symptom Assessment Form v4.0 Total Symptom Score ≥ 10) adults with MF with prior Janus kinase inhibitor experience, including both transfusion-dependent (TD) and transfusion-independent (TI) patients. Twenty participants (5 TD, 15 TI) completed interviews to inform an online survey fielded among 155 (76 TD, 51 TI, 28 transfusion-naive) participants. Questions assessed perceived and experienced burdens and impacts of anemia and transfusions. Results: Concept elicitation interviews ( N = 20) identified safety (85%), convenience (85%), and travel requirements (60%) as top concerns associated with transfusions; 40% noted symptom relief from transfusions, and 90% valued treatments to control anemia and reduce transfusion need. Across online survey participants ( N = 155), fatigue (85.2%), weakness (72.9%), and headaches (47.7%) were the most frequently reported symptoms, with negative impacts to daily activities (73%), physical activities (56%), ability to think (54%), and emotional health (53%). Transfusion-related inconveniences included time spent at the clinic (81%), travel time (40%), and scheduling issues (32%). The most burdensome impacts of transfusions were to daily activities (55.5%), emotional health (52.3%), and family responsibilities (35.5%). Among TD participants, 52.2% rated reducing their needed transfusion frequency as “extremely important,” although some acknowledged benefits associated with symptom relief. Conclusions: This study underscores the significant symptom burden of anemia and the broad impacts of transfusion dependence in MF. Qualitative and quantitative findings reveal emotional, physical, and logistical challenges associated with transfusions and patients’ strong desire to minimize their frequency. Results support the development of patient-centered therapies that improve anemia and reduce transfusions, addressing key medical needs in MF management.

1. Acute myeloid leukemia (AML) is an aggressive hematologic cancer, associated with high mortality, and substantial clinical and patient burden [1–3]. It is the most common form of acute leukemia ...

Despite advances in care for acute myeloid leukemia (AML), long-term outcomes remain poor, with a 5-year relative survival of 32% [1]. Over the past three decades, intensive chemotherapy (IC) has b...

Palliative care, or care that aims to reduce suffering, manage symptoms, and improve quality‐of‐life for those living with serious illness, is recognized as essential to high‐quality cancer care. However, challenges to equitable and timely access and integration persist. Scientific and clinical practice advances in recent years have made considerable progress in leveraging technology and improving workflows for more efficient and scalable palliative care delivery, while also expanding palliative and supportive care services for patients across cancer types. In parallel, treatment advances have emerged to better address complex cancer–related symptoms alongside growing interest in technology to aid in symptom monitoring. These advances offer promising solutions for a future in which palliative and supportive care strategies are more readily accessible, and avoidable suffering for patients with cancer is prevented and/or relieved with evidence‐based and clinically useful approaches.

Claire Wang, B.S. and Thomas W LeBlanc, M.D., M.A., MHS. J Hosp Palliat Care 2025;28:121-30. https://doi.org/10.14475/jhpc.2025.28.4.121

Aim To investigate whether early referral to specialist palliative care (SPC) is cost-effective compared to standard care for people ≥ 60 years of age with newly diagnosed acute myeloid leukaemia (AML). Methods A modelled cost-utility analysis, from an Australian public healthcare system perspective, over a 5-year time horizon. A systematic review of studies reporting health state utility values (HSUVs), or convertible health-related quality of life measures, provided values for the decision tree model. Cost and effectiveness data were sourced from a broad review of the literature. All costs were estimated using 2022 Australian prices. Scenario analyses and sensitivity analyses explored the impact of varying key assumptions on the results. To account for uncertainty in the model, the mean of Monte Carlo simulation with 10,000 iterations, and 95% uncertainty intervals were reported for base case and scenario analyses results. Results For the deterministic base case, SPC was associated with mean incremental cost-saving (AUD −$2805) and greater mean incremental quality-adjusted life years (QALYs [0.05]). In probabilistic sensitivity analysis, the probability of SPC being cost-effective or dominant was 57.3%. In scenario analyses, SPC dominated standard care in all eight scenarios. In one-way sensitivity analysis, results were sensitive to utility values in treatment-related health states. Conclusions Findings indicate early SPC is likely to be cost-saving and more effective than standard care. Results must be interpreted cautiously given the reliance on assumptions and uncertainty of inputs in the model. However, findings are promising and warrant further research.

Hematopoietic stem cell (HSCT) and chimeric antigen receptor T-cell (CAR-T) therapy are crucial in the treatment of hematologic malignancies. While HSCT has been long established as a mainstay of the treatment of these diseases, CAR-T is a newer therapy with the potential to change the treatment landscape. Both cellular therapies are time and resource intensive, which has put stressors on patients that are unique from those associated with other forms of oncologic treatment. In this review, we discuss the current state of knowledge of psychological symptoms associated with HSCT and CAR-T and their management. In addition, we discuss the models of patient reported outcomes (PROs) used to perform this research. We performed a literature review on PubMed using keywords including, 'palliative care, palliative care integration, hematologic malignancy, patient reported outcome, psychological care, and quality of life.' We included papers published before 1 April 2025. We propose further investigations into integrated models of oncologic and palliative care teams and their efficacy.

PURPOSE: Goals-of-care (GOC) discussions during advanced serious illness and end-of-life (EOL) care are critical. Institutions are increasingly tracking the frequency and timing of GOC documentation, but large-scale content assessments have been limited. We aimed to use natural language processing (NLP) to assess GOC documentation quality and associations with EOL care for patients with cancer. METHODS: This is a retrospective review of patients at a single US center who died with cancer between 2018 and 2022, and had documented GOC notes in the last 12 months of life. Eight GOC components were identified: current understanding of illness, information preferences, prognostic disclosure, goals, fears, acceptable function, trade-offs, and family involvement. NLP software searched for the aggregate presence of these components at the patient level within extracted GOC notes. We evaluated associations between these eight components and receipt of aggressive EOL care (chemotherapy within 14 days of death, no hospice care, or hospice admission ≤3 days of death). RESULTS: Two thousand thirty-one patients met inclusion criteria. The most common GOC component addressed was family involvement (75.0%) and the least common was fears (21.1%). Only 5.4% had all eight components documented. More comprehensive GOC notes were associated with lower rates of aggressive EOL care; 73.2% received aggressive care when 0/8 components were documented, compared with 56.8% and 50.3% with six or seven components discussed, respectively. In multivariate logistic regression, GOC components documented (≤6 v ≥7: OR, 2.13; P < .0001) and primary tumor site (lymphoma: OR, 2.86; P < .0001) were independent predictors of aggressive EOL care. CONCLUSION: Increasingly comprehensive and higher-quality GOC documentation is associated with a lower likelihood of receiving aggressive EOL care. Opportunities to improve the quality and documentation of GOC conversations may affect EOL care for patients with cancer.