Table 2 Characteristics and pathways of haematological malignancies
Uncertainty and unpredictability ‘generally, oncology patients follow a kind of downwards steady decline…whereas haematology patients just peak and trough, so it’s hard to predict what somebody is going to do’ (SPC nurse 7) ‘I don’t think it’s quite as easy to predict a lot of the trajectories as it is for some of the other malignancies…it’s not that simple for the haematologists’ (SPC doctor 3) |
Lack of clear transition points and treatment late in the pathway ‘other cancers, the oncologists will say “actually there’s no further treatment we can offer at the moment because the side effects are going to outweigh all the benefits now”…they will then discharge them into the community, with the GP. Patients with haematological malignancies tend to get treated and treated and treated…’ (SPC nurse 5) ‘haematologists give more aggressive treatments and do treat up until late into a disease stage, but I think there just is this idea of potentially more to gain’ (SPC doctor 4) ‘even when they’re [patients] on the brink of really being extremely poorly, some weird and wonderful medicines can actually bring them back’ (SPC doctor 3) |
Patients’ desire to pursue treatment ‘there was a patient who, even with having a really detailed conversation with a consultant and his family about the poor, poor prognostic outcome of maybe fourth line chemotherapy…the patient wanted to, to take it’ (SPC nurse 14) |