Major Challenges for Palliative Care in Oncohematology: Analysis of the “Surprise Question” in a Reference Center

Introduction: Despite advances in the treatment of hematologic malignancies (HM), a significant number of patients still present with high burden of symptoms, and many still die from their diseases. Adequate integration of palliative care (PC) shows strong potential to improve quality of life of this population. However, PC strategies are underutilized due to several barriers in the context of high prognosis uncertainty. Therefore, it is crucial to implement practical tools and triggers for opportune discussions concerning goals of care and specialist PC consultations. The “Surprise-Question” (SQ) “Would you be surprised if this patient died in the next 12 months?” is a simple and feasible instrument for intuitive estimation of mortality among patients with different types of advanced disease with the aim to improve prognostic awareness among healthcare professionals. In 2016 this instrument was introduced in the American Society of Clinical Oncology (ASCO) Integration of Palliative Care Into Standard Oncology Care Guideline. Most studies refer the SQ to solid tumors and very little is known about the application of this tool in the context of HM. We evaluated the prognostic performance of the SQ among patients with HM.