Palliative care in patients with haematological neoplasms: An integrative systematic review

Abstract

Background:

Palliative care was originally intended for patients with non-haematological neoplasms and relatively few studies have assessed palliative care in patients with haematological malignancies.

Aim:

To assess palliative care interventions in managing haematological malignancies patients treated by onco-haematology departments.

Design:

Integrative systematic review with data extraction and narrative synthesis (PROSPERO #: CRD42016036240).

Data sources:

PubMed, CINAHL, Cochrane, Scopus and Web-of-Science were searched for articles published through 30 June 2015. Study inclusion criteria were as follows: (1) published in English or Spanish and (2) containing data on palliative care interventions in adults with haematological malignancies.

Results:

The search yielded 418 articles; 99 met the inclusion criteria. Six themes were identified: (1) end-of-life care, (2) the relationship between onco-haematology and palliative care departments and referral characteristics, (3) clinical characteristics, (4) experience of patients/families, (5) home care and (6) other themes grouped together as ‘miscellany’. Our findings indicate that palliative care is often limited to the end-of-life phase, with late referral to palliative care. The symptom burden in haematological malignancies patients is more than the burden in non-haematological neoplasms patients. Patients and families are generally satisfied with palliative care. Home care is seldom used. Tools to predict survival in this patient population are lacking.

Conclusion:

Despite a growing interest in palliative care for haematological malignancies patients, the evidence base needs to be strengthened to expand our knowledge about palliative care in this patient group. The results of this review support the need to develop closer cooperation and communication between the palliative care and onco-haematology departments to improve patient care.

Keywords

Haematological malignancies haematologic neoplasms palliative care palliative medicine terminal care dying and end of life

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References

Saunders

The terminal care support team. Nursing 1980; 15: 657–659.

Borasio

Voltz

Palliative care in amyotrophic lateral sclerosis. J Neurol 1997; 244: S11–S17.

Fontaine

Larue

Lassaunière

JM.

Physicians’ recognition of the symptoms experienced by HIV patients: how reliable?

J Pain Symptom Manage 1999; 18: 263–270.

Maltoni

Nanni

Pirovano

et al . Successful validation of the palliative prognostic score in terminally ill cancer patients. Italian Multicenter Study Group on Palliative Care. J Pain Symptom Manage 1999; 17: 240–247.

Teunissen

Wesker

Kruitwagen

et al . Symptom prevalence in patients with incurable cancer: a systematic review. J Pain Symptom Manage 2007; 34: 94–104.

Manitta

Philip

Cole-Sinclair

MF.

Palliative care and the hemato-oncological patient: can we live together? A review of the literature. J Palliat Med 2010; 13: 1021–1025.

Hui

Bansai

Park

et al . Differences in attitudes and beliefs toward end-of-life care between hematologic and solid tumor oncology specialists. Ann Oncol 2015; 26: 1440–1446.

Fadul

El Osta

Dalal

et al . Comparison of symptom burden among patients referred to palliative care with hematologic malignancies versus those with solid tumors. J Palliat Med 2008; 11: 422–427.

LeBlanc

Smith

Currow

DC.

Symptom burden of haematological malignancies as death approaches in a community palliative care service: a retrospective cohort study of a consecutive case series. Lancet Haematol 2015; 2: e334–e338.

10.

Porta-Sales

Codorniu

Gómez-Batiste

et al . Patient appointment process, symptom control and prediction of follow-up compliance in a palliative care outpatient clinic. J Pain Symptom Manage 2005; 30: 145–153.

11.

Gomez-Batiste

Porta-Sales

Espinosa-Rojas

et al . Effectiveness of palliative care services in symptom control of patients with advanced terminal cancer: a Spanish, multicenter, prospective, quasi-experimental, pre-post study. J Pain Symptom Manage 2010; 40: 652–660.

12.

Higginson

Evans

CJ.

What is the evidence that palliative care teams improve outcomes for cancer patients and their families?

Cancer J 2010; 16: 423–435.

13.

Gomes

Calanzani

Curiale

et al . Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev 2013; 6: CD007760.

14.

Murray

Boyd

Sheikh

Palliative care in chronic illness. BMJ 2005; 330: 611–612.

15.

Oishi

Murtagh

FE.

The challenges of uncertainty and interprofessional collaboration in palliative care for non-cancer patients in the community: a systematic review of views from patients, carers and health-care professionals. Palliat Med 2014; 28: 1081–1098.

16.

Moens

Higginson

Harding

et al . Are there differences in the prevalence of palliative care-related problems in people living with advanced cancer and eight non-cancer conditions? A systematic review. J Pain Symptom Manage 2014; 48: 660–677.

17.

Tazi

Nafil

Mahmal

Palliative care in hematology: what is the future in Africa?

Pan Afr Med J 2011; 8: 8, http://www.panafrican-med-journal.com/content/article/8/8/full/

18.

Serrano Bermúdez

Porta-Sales

González-Barboteo

et al . Neoplasias hematológicas y cuidados paliativos: revisión sistemática de la literatura [Haematological malignancies and palliative care: a systematic literature review.]. Palliat Med 2012; 19: 73–80.

19.

Corbett

Johnstone

Trauer

et al . Palliative care and hematological malignancies: increased referrals at a comprehensive cancer centre. J Palliat Med 2013; 16: 537–541.

20.

Odejide

Salas Coronado

Watts

et al . End-of-life care for blood cancers: a series of focus groups with hematologic oncologists. J Oncol Pract 2014; 10: e396–e403.

21.

LeBlanc

El-Jawahri

When and why should patients with hematologic malignancies see a palliative care specialist. Hematology 2015; 2015: 471–478.

22.

Moher

Liberati

Tetzlaff

et al . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009; 62: 1006–1012.

23.

Whittemore

Knafl

The integrative review: updated methodology. J Adv Nurs 2005; 52: 546–553.

24.

Carroll

Booth

Lloyd-Jones

Should we exclude inadequately reported studies from qualitative systematic reviews? An evaluation of sensitivity analyses in two case study reviews. Qual Health Res 2012; 22: 1425–1434.

25.

Neuss

Feussner

DeLong

et al . A quantitative analysis of palliative care decisions in acute non lymphocytic leukemia. J Am Geriatr Soc 1987; 35: 125–131.

26.

Randall

Terminal care in haematology. Baillieres Clin Haematol 1987; 1: 581–591.

27.

Maddocks

Bentley

Sheedy

Quality of life issues in patients dying from haematological diseases. Ann Acad Med 1994; 23: 244–248.

28.

Lassauniere

Bertolino

Hunault

et al . Platelet transfusions in advanced hematological malignancies: a position paper. J Palliat Care 1996; 12: 38–41.

29.

Girmenia

Moleti

Cartoni

et al . Management of infective complications in patients with advanced hematologic malignancies in home care. Leukemia 1997; 11: 1807–1812.

30.

Mander

Haematology and palliative care: an account of shared care for a patient undergoing bone marrow transplantation for chronic myeloid leukaemia. Int J Nurs Pract 1997; 3: 62–66.

31.

Stockelberg

Lehtola

Norén

Palliative treatment at home for patients with haematological disorders. Support Care Cancer 1997; 5: 506–508.

32.

McGrath

Palliative care for patients with hematological malignancies – if not, why not?

J Palliat Care 1999; 15: 24–30.

33.

Kelly

Ross

Gray

et al . Death, dying and emotional labour: problematic dimensions of the bone marrow transplant nursing role? J Adv Nurs 2000; 32: 952–960.

34.

McGrath

Caregivers’ insights on the dying trajectory in hematology oncology. Cancer Nurs 2001; 24: 413–421.

35.

McGrath

. Dying in the curative system: the haematology/oncology dilemma. Part 1. Aust J Holist Nurs 2001; 8: 22–30.

36.

Middlewood

Gardner

Dying in hospital: medical failure or natural outcome?

J Pain Symptom Manage 2001; 22: 1035–1041.

37.

Stalfelt

Brodin

Pettersson

et al . The final phase in acute myeloid leukaemia (AML): a study of cause of death, place of death and type of care during the last week of life. Leuk Res 2001; 25: 673–680.

38.

Maltoni

Amadori

Prognosis in advanced cancer. Hematol Oncol Clin North Am 2002; 16: 715–729.

39.

McGrath

End-of-life care for hematological malignancies: the ‘technological imperative’ and palliative care. J Palliat Care 2002; 18: 39–47.

40.

McGrath

Qualitative findings on the experience of end-of-life care for hematological malignancies. Am J Hosp Palliat Care 2002; 19: 103–111.

41.

McGrath

Are we making progress? Not in haematology!

Omega 2002; 45: 331–348.

42.

McGrath

Joske

Palliative care and haematological malignancy: a case study. Aust Health Rev 2002; 25: 60–66.

43.

McGrath

. Dying in the curative system: the haematology/oncology dilemma. Part 2. Aust J Holist Nurs 2002; 9: 14–21.

44.

Auret

Bulsara

Joske

Australasian haematologist referral patterns to palliative care: lack of consensus on when and why. Intern Med J 2003; 33: 566–571.

45.

Boyce

McHugh

Lyon

Proactive palliative care choices for haematology day unit patients. Int J Palliat Nurs 2003; 9: 544–550.

46.

McGrath

Clarke

Creating the space for spiritual talk: insights from survivors of haematological malignancies. Aust Health Rev 2003; 26: 116–132.

47.

Stalfelt

Brodin

Pettersson

et al . The final phase in acute myeloid leukaemia (AML): a study on bleeding, infection and pain. Leuk Res 2003; 27: 481–488.

48.

McGrath

Strategies for coping with spiritual pain: a comparison of insights from survivors and hospice patients. Aust J Holist Nurs 2004; 11: 4–15.

49.

Cheng

Willey

Palmer

et al . Interval between palliative care referral and death among patients treated at a comprehensive cancer center. J Palliat Med 2005; 8: 1025–1032.

50.

Costantini

Beccaro

Merlo

et al . The last three months of life of Italian cancer patients. Methods, sample characteristics and response rate of the Italian Survey of the Dying of Cancer (ISDOC). Palliat Med 2005; 19: 628–638.

51.

Shirai

Kawa

Miyashita

et al . Nurses’ perception of adequacy of care for leukemia patients with distress during the incurable phase and related factors. Leuk Res 2005; 29: 293–300.

52.

Tzala

Lord

Ziras

et al . Cost of home palliative care compared with conventional hospital care for patients with haematological cancers in Greece. Eur J Health Econ 2005; 6: 102–106.

53.

Deschler

de Witte

Mertelsmann

et al . Treatment decision-making for older patients with high-risk myelodysplastic syndrome or acute myeloid leukemia: problems and approaches. Haematologica 2006; 91: 1513–1522.

54.

McGrath

Holewa

Missed opportunities: nursing insights on end-of-life care for haematology patients. Int J Nurs Pract 2006; 12: 295–301.

55.

Niscola

de Fabritiis

Cartoni

et al . Home care management of patients affected by hematologic malignancies: a review. Haematologica 2006; 91: 1523–1529.

56.

Ansell

Howell

Garry

et al . What determines referral of UK patients with haematological malignancies to palliative care services? An exploratory study using hospital records. Palliat Med 2007; 21: 487–492.

57.

Cartoni

Brunetti

D’Elia

et al . Cost analysis of a domiciliary program of supportive and palliative care for patients with hematologic malignancies. Haematologica 2007; 92: 666–673.

58.

Fadul

Elsayem

Palmer

et al . Predictors of access to palliative care services among patients who died at a comprehensive cancer center. J Palliat Med 2007; 10: 1146–1152.

59.

McGrath

Care of the haematology patient and their family – the GP viewpoint. Aust Fam Physician 2007; 36: 779–781.

60.

McGrath

Holewa

Special considerations for haematology patients in relation to end-of-life care: Australian findings. Eur J Cancer Care 2007; 16: 164–171.

61.

McGrath

Holewa

HA.

Description of an Australian model for end-of-life care in patients with hematologic malignancies. Oncol Nurs Forum 2007; 34: 79–85.

62.

Niscola

Cartoni

Romani

et al . Epidemiology, features and outcome of pain in patients with advanced hematological malignancies followed in a home care program: an Italian survey. Ann Hematol 2007; 86: 671–676.

63.

Earle

Landrum

Souza

et al . Aggressiveness of cancer care near the end of life: is it a quality-of-care issue? J Clin Oncol 2008; 26: 3860–3866.

64.

Cartoni

Niscola

Breccia

et al . Hemorrhagic complications in patients with advanced hematological malignancies followed at home: an Italian experience. Leuk Lymphoma 2009; 50: 387–391.

65.

Chung

Lyckholm

Smith

TJ.

Palliative care in BMT. Bone Marrow Transplant 2009; 43: 265–273.

66.

Costantini

Ripamonti

Beccaro

et al . Prevalence, distress, management, and relief of pain during the last 3 months of cancer patients’ life. Results of an Italian mortality follow-back survey. Ann Oncol 2009; 20: 729–735.

67.

Delgado-Guay

Parsons

et al . Symptom distress, interventions, and outcomes of intensive care unit cancer patients referred to a palliative care consult team. Cancer 2009; 115: 437–445.

68.

Johnsen

Tholstrup

Petersen

et al . Health related quality of life in a nationally representative sample of haematological patients. Eur J Haematol 2009; 83: 139–148.

69.

Kodama

Takita

Kawagoe

et al . Retrospective study on home care for patients with hematologic malignancies. Jpn J Clin Oncol 2009; 39: 606–611.

70.

McGrath

Leahy

Catastrophic bleeds during end-of-life care in haematology: controversies from Australian research. Support Care Cancer 2009; 17: 527–537.

71.

Tang

Hung

et al . Determinants of aggressive end-of-life care for Taiwanese cancer decedents, 2001 to 2006. J Clin Oncol 2009; 27: 4613–4618.

72.

Elsayem

Mori

Parsons

et al . Predictors of inpatient mortality in an acute palliative care unit at a comprehensive cancer center. Support Care Cancer 2010; 18: 67–76.

73.

Grulke

Bailer

Facing haematopoietic stem-cell transplantation: do patients and their physicians agree regarding the prognosis?

Psychooncology 2010; 19: 1035–1043.

74.

Hill

QA.

Intensify, resuscitate or palliate: decision making in the critically ill patient with haematological malignancy. Blood Rev 2010; 24: 17–25.

75.

Howell

Roman

Cox

et al . Destined to die in hospital? Systematic review and meta-analysis of place of death in haematological malignancy. BMC Palliat Care 2010; 9: 9.

76.

Jarlbaek

Hansen

Bruera

et al . Frequency of opioid use in a population of cancer patients during the trajectory of the disease. Clin Oncol 2010; 22: 199–207.

77.

Parsons

Cruz

Zhukovsky

et al . Characteristics of patients who refuse do-not-resuscitate orders upon admission to an acute palliative care unit in a comprehensive cancer center. Cancer 2010; 116: 3061–3070.

78.

Buss

Lessen

Sullivan

et al . Hematology/oncology fellows’ training in palliative care: results of a national survey. Cancer 2011; 117: 4304–4311.

79.

Cooke

Gemmill

Grant

ML.

Creating a palliative educational session for hematopoietic stem cell transplantation recipients at relapse. Clin J Oncol Nurs 2011; 15: 411–417.

80.

Howell

Shellens

Roman

et al . Haematological malignancy: are patients appropriately referred for specialist palliative and hospice care? A systematic review and meta-analysis of published data. Palliat Med 2011; 25: 630–641.

81.

Loberiza

Jr Swore-Fletcher

Block

et al . Coping styles, health status and advance care planning in patients with hematologic malignancies. Leuk Lymphoma 2011; 52: 2342–2348.

82.

Manitta

Zordan

Cole-Sinclair

et al . The symptom burden of patients with hematological malignancy: a cross-sectional observational study. J Pain Symptom Manage 2011; 42: 432–442.

83.

McGrath

. Back to the future: a research journey in haematology and palliative care. In: Plunkett

(ed.) Palliative and nursing home care: policies, challenges and quality of Life. New York: Nova Science Publishers, 2011; pp. 87–100.

84.

Nightingale

Monsell

Wong

et al . How to give haematology patients better end-of-life care. Eur J Palliat Care 2011; 18: 114–117.

85.

Saini

Alibhai

Brandwein

JM.

Quality of life issues in elderly acute myeloid leukemia patients. Aging Health 2011; 7: 477–490.

86.

Snowden

Ahmedzai

Ashcroft

et al . Guidelines for supportive care in multiple myeloma 2011. Br J Haematol 2011; 154: 76–103.

87.

Vollmer

Wittmann

Schweiger

et al . Preoccupation with death as predictor of psychological distress in patients with haematologic malignancies. Eur J Cancer Care 2011; 20: 403–411.

88.

Albrecht

Rosenzweig

Management of cancer related distress in patients with a hematological malignancy. J Hosp Palliat Nurs 2012; 14: 462–468.

89.

Brück

Pierzchlewska

Kaluzna-Oleksy

et al . Dying of hematologic patients – treatment characteristics in a German University Hospital. Support Care Cancer 2012; 20: 2895–2902.

90.

Efficace

Cartoni

Niscola

et al . Predicting survival in advanced hematologic malignancies: do patient-reported symptoms matter? Eur J Haematol 2012; 89: 410–416.

91.

Epstein

Goldberg

Meier

DE.

Palliative care and hematologic oncology: the promise of collaboration. Blood Rev 2012; 26: 233–239.

92.

Halawi

Aldin

Baydoun

et al . Physical symptom profile for adult cancer inpatients at a Lebanese cancer unit. Eur J Intern Med 2012; 23: e185–e189.

93.

Hui

Kim

Kwon

et al . Access to palliative care among patients treated at a comprehensive cancer center. Oncologist 2012; 17: 1574–1580.

94.

Leung

Esplen

Peter

et al . How haematological cancer nurses experience the threat of patients’ mortality. J Adv Nurs 2012; 68: 2175–2184.

95.

Stark

Tofthagen

Visovsky

et al . The symptom experience of patients with cancer. J Hosp Palliat Nurs 2012; 14: 61–70.

96.

Thomas

Crisp

Campbell

The importance of quality of life for patients living with myelodysplastic syndromes. Clin J Oncol Nurs 2012; 16: 47–57.

97.

Alonso-Babarro

Astray-Mochales

Domínguez-Berjón

et al . The association between in-patient death, utilization of hospital resources and availability of palliative home care for cancer patients. Palliat Med 2013; 27: 68–75.

98.

Boland

Eiser

Ezaydi

et al . Living with advanced but stable multiple myeloma: a study of the symptom burden and cumulative effects of disease and intensive (hematopoietic stem cell transplant-based) treatment on health-related quality of life. J Pain Symptom Manage 2013; 46: 671–680.

99.

Howell

Wang

Smith

et al . Place of death in haematological malignancy: variations by disease sub-type and time from diagnosis to death. BMC Palliat Care 2013; 12: 42.

100.

Hung

Chang

et al . Characteristics of patients with hematologic malignancies who received palliative care consultation services in a medical center. Am J Hosp Palliat Care 2013; 30: 773–780.

101.

McGrath

End-of-life care in hematology: update from Australia. J Soc Work End Life Palliat Care 2013; 9: 96–110.

102.

Zimmermann

Yuen

Mischitelle

et al . Symptom burden and supportive care in patients with acute leukemia. Leuk Res 2013; 37: 731–736.

103.

Boland

Ezaydi

et al . Holistic needs assessment in advanced, intensively treated multiple myeloma patients. Support Care Cancer 2014; 22: 2615–2620.

104.

Button

Gavin

Keogh

SJ.

Exploring palliative care provision for recipients of allogeneic hematopoietic stem cell transplantation who relapsed. Oncol Nurs Forum 2014; 41: 370–381.

105.

Howell

Wang

Roman

et al . Variations in specialist palliative care referrals: findings from a population-based patient cohort of acute myeloid leukaemia, diffuse large B-cell lymphoma and myeloma. BMJ Support Palliat Care 2015; 5: 496–502.

106.

Hui

Didwaniya

Vidal

et al . Quality of end-of-life care in patients with hematologic malignancies: a retrospective cohort study. Cancer 2014; 120: 1572–1578.

107.

Kripp

Willer

Schmidt

et al . Patients with malignant hematological disorders treated on a palliative care unit: prognostic impact of clinical factors. Ann Hematol 2014; 93: 317–325.

108.

Niscola

Tendas

Scaramucci

et al . End of life care in hematology: still a challenging concern. Ann Palliat Med 2014; 3: 7–11.

109.

O’Connor

Harris

et al . Hospice admissions for cancer in the final days of life: independent predictors and implications for quality measures. J Clin Oncol 2014; 32: 3184–3189.

110.

Riolfi

Buja

Zanardo

et al . Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: a retrospective cohort study. Palliat Med 2014; 28: 403–411.

111.

Sexauer

Cheng

Knight

et al . Patterns of hospice use in patients dying from hematologic malignancies. J Palliat Med 2014; 17: 195–199.

112.

Wright

Forbes

Haematologists’ perceptions of palliative care and specialist palliative care referral: a qualitative study. BMJ Support Palliat Care 2017; 7: 39–45.

113.

Zordan

Manitta

Nandurkar

et al . Prevalence and predictors of fatigue in haemo-oncological patients. Intern Med J 2014; 44: 1013–1017.

114.

Cheng

Chan

et al . End-of-life characteristics and palliative care provision for elderly patients suffering from acute myeloid leukemia. Support Care Cancer 2015; 23: 111–116.

115.

Cheng

Sham

Chan

et al . Intensive palliative care for patients with hematological cancer dying in hospice: analysis of the level of medical care in the final week of life. Am J Hosp Palliat Care 2015; 32: 221–225.

116.

LeBlanc

Abernethy

Casarett

DJ.

What is different about patients with hematologic malignancies? A retrospective cohort study of cancer patients referred to a hospice research network. J Pain Symptom Manage 2015; 49: 505–512.

117.

LeBlanc

O’Donnell

Crowley-Matoka

et al . Perceptions of palliative care among hematologic malignancy specialists: a mixed-methods study. J Oncol Pract 2015; 11: e230–238.

118.

Temel

Greer

Muzikansky

et al . Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010; 363: 733–742.

119.

Otsuka

Koyama

Matsuoka

et al . Early palliative intervention for patients with advanced cancer. Jpn J Clin Oncol 2013; 43: 788–794.

120.

Porta-Sales

Moreno-Alonso

Guerrero-Torrelles

et al . Cuidados paliativos en hematología clínica: experiencia de una consulta integrativa en pacientes con mieloma multiple [Palliative care in clinical haematology: experience of an integrative outpatient clinic in patients with multiple myeloma] Med Paliat Epub ahead of print 31 March 2016. DOI: 10.1016/j.medipa.2016.01.002.

121.

Gómez-Batiste

Espinosa

Porta-Sales

et al . Modelos de atención, organización y mejora de la calidad para la atención de los enfermos en fase terminal y su familia: aportación de los cuidados paliativos [Models of care, organization and quality improvement for the care of advanced and terminal patients and their families: the contribution of palliative care] Med Clin 2010; 135: 83–89.

122.

Loggers

LeBlanc

El-Jawahri

et al . Pretransplantation supportive and palliative care consultation for high-risk hematopoietic cell transplantation patients. Biol Blood Marrow Transplant 2016; 22: 1299–1305.

123.

El-Jawahri

LeBlanc

VanDusen

et al . Effect of inpatient palliative care on quality of life 2 weeks after hematopoietic stem cell transplantation: a randomized clinical trial. JAMA 2016; 316: 2094–2103.

124.

Gómez-Batiste

Martínez-Muñoz

Blay

et al . Identifying patients with chronic conditions in need of palliative care in the general population: development of the NECPAL tool and preliminary prevalence rates in Catalonia. BMJ Support Palliat Care 2013; 3: 300–308.

125.

McCaughan

Roman

Smith

et al . Determinants of hospital death in haematological cancers: findings from a qualitative study. BMJ Support Palliat Care Epub ahead of print 29 June 2017. DOI: 10.1136/bmjspcare-2016-001289.

126.

Higginson

Evans

Grande

et al . Evaluating complex interventions in end of life care: the MORECare statement on good practice generated by a synthesis of transparent expert consultations and systematic reviews. BMC Medicine 2013; 11: 111.

127.

Guo

Jacelon

CS.

An integrative review of dignity in end-of-life care. Palliat Med 2014; 28: 931–940.

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