Areej El-Jawahri, MD
Palliative care can improve quality of life for patients hospitalized for hematopoietic stem cell transplantation (HCT), according to a study presented at the recent 2016 Palliative Care in Oncology Symposium.
“Hematopoietic stem cell transplantation is an intensive potentially curative therapy for patients with hematologic malignancies,” said lead author Areej El-Jawahri, MD. “However, patients who undergo the procedure experience physical and psychological symptoms that can negatively affect quality of life and mood.”
In the study, 160 patients with hematologic malignancies admitted for autologous or allogeneic HCT were randomized into two groups; 81 patients received the inpatient palliative care intervention integrated with transplant care, and 79 received transplant care alone. Most participants were white, female and over 50 years of age.
During integrated palliative and transplant care, patients had at least 2 weekly visits during hospitalization. For those patients getting only transplant care, palliative care was available upon request.
Patients were accessed for quality of life, symptom burden and mood during week 2 after transplant, then again at 3 months post-HCT. The 6-month assessment results have not yet been revealed.
The research team, led by El-Jawahri, an oncologist specializing in hematologic malignancies at Massachusetts General Hospital Cancer Center in Boston used the Functional Assessment of Cancer Therapy-Bone Marrow Transplant to assess quality of life; the Hospital Anxiety and Depression Scale and Patient Health Questionnaire to assess mood; and Edmonton Symptom Assessment Scale to measure symptoms at baseline, week 2 and 3 months post-HCT. Post-traumatic stress (PTSD) symptoms were measured using the PTSD checklist at baseline and 3 months post-HCT.
At week 2, there were improvements in quality of life, depression, anxiety and symptom burden in the intervention group. At 3 months, the intervention led to improvements in quality of life, depression, and PTSD.
“Palliative care physicians were asked to document what they focused on during the palliative care visits and during the initial consultation visit,” explained El-Jawahri. “Predominantly, they focused on symptoms, establishing rapport with patients and families, as well as coping. When it came to specific symptoms, they focused on pain, nausea, constipation, and diarrhea.”
Overall, researchers concluded that intervention has a positive effect on quality of life, depression, anxiety and symptom burden in patients hospitalized for HCT. Those improvements also remained 3 months post-HCT.
The authors noted that involvement of palliative care for patients with hematologic malignancies can improve their outcomes and substantially reduce the morbidity of HCT.
“This is important because this is really the first study showing the benefits of palliative care for patients with hematologic malignancies undergoing curative therapy,” El-Jawahri said.
El-Jawahri urged more multisite randomized controlled trials to demonstrate the efficacy of the care model for patients hospitalized for HCT. Future studies are needed to evaluate the impact of early integration for this population on illness understanding and end-of-life outcomes.
El-Jawahri A, LeBlanc TW, Van Dusen H, et al. Randomized trial of inpatient palliative care in patients hospitalized for hematopoietic stem cell transplantation (HCT). J Clin Oncol.
2016;34(suppl 26S; abstr 103).