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摘要

肿瘤学家也接受血液学方面的培训,经常治疗血液恶性肿瘤患者,如白血病和淋巴瘤。尽管白血病母细胞和肺癌细胞在生物学行为上可能没有什么不同,但医生们仍然普遍认为死于复发性急性白血病和死于进展性肺癌是不同的。为了证实这一假设,只需回顾最新的血液学教科书中关于疼痛和症状管理以及心理治疗的章节,这一点将是显而易见的。此外,Pam McGrath1在本期《美国临终关怀与姑息治疗杂志》上发表的文章证实了这样一种观点,即死于血液恶性肿瘤的患者在姑息治疗方面很少得到关注。在这项必读的研究中,McGrath1采访了10例以男性为主的血液恶性肿瘤患者的女性护理人员,即5例急性淋巴细胞白血病,2例急性髓细胞白血病,1例慢性髓细胞白血病,1例慢性淋巴细胞白血病,1例淋巴瘤。这些访谈的定性分析是基于数据饱和的原则,也就是说,当一些参与者说同样的事情时,共同的主题就会出现。从这项研究中得出了几个重要的观察结果,包括:
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Dying from hematological cancers
oncologists are also trained in hematology and often care for patients with hematological malignancies, such as leukemia and lymphoma. Although there may be little difference in biologic behavior between a leukemic blast cell and a lung cancer cell, there remains a common perception among physicians that dying from relapsed acute leukemia and progressive lung cancer differ. To substantiate this assumption, just review the most recent hematological textbooks for chapters on pain and symptom management as well as psychological treatment and the point will be obvious. Furthermore, the article in this issue of the American Journal of Hospice & Palliative Care by Pam McGrath1 validates the idea that patients dying with hematological malignancies are given scant attention in regard to palliative care. In this must-read study, McGrath1 interviewed the mostly female caregivers of 10 predominantly male patients with blood malignancies, i.e., five had acute lymphocytic leukemia, two had acute myeloblastic leukemia, one had chronic myelocytic leukemia, one had chronic lymphocytic leukemia, and one had lymphoma. The qualitative analysis of these interviews was based on the principle of saturation of data, that is, common themes emerge when a number of the participants say the same thing. Several important observations were made from this study including:
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