Palliative Care 2016: Inpatient Palliative Care in Patients Hospitalized for HSCT

Key Points

  • At both 2 weeks and 3 months post-HSCT, the inpatient palliative care intervention led to improvements in quality of life, depression, anxiety, and symptom burden.
  • PHQ-9 scores at 2 weeks and HADS-anxiety scores at 3 months did not differ significantly.

During hematopoietic stem cell transplantation (HSCT), patients sometimes experience physical and psychological symptoms that negatively impact their quality of life. Researchers led by Areej El-Jawahri, MD, Instructor of Medicine at Harvard Medical School, Director of the Bone Marrow Transplant Survivorship Program at the Massachusetts General Hospital, and Associate Director of Massachusetts General Hospital Cancer Center Survivorship Program, assessed the impact of an inpatient palliative care intervention on patient quality of life, symptom burden, and mood during HSCT hospitalization and at 3 months post-HSCT. Their findings were presented at the 2016 Palliative Care in Oncology Symposium in San Francisco, California (Abstract 103).

Methods

One hundred and sixty patients with hematologic malignancies admitted for autologous or allogeneic HSCT were randomized to an inpatient palliative care intervention (n = 81) integrated with transplant care, or to transplant care alone (n=79). Researchers used the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) to assess quality of life; the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire (PHQ-9) to assess mood; and the Edmonton Symptom Assessment Scale (ESAS) to measure symptoms at baseline and then 2 weeks and 3 months post-HSCT. The team measured post-traumatic stress (PTSD) symptoms using the PTSD checklist at baseline and 3 months post-HSCT. They also used linear regression models controlling for baseline values to assess the intervention effects on outcomes at 2 weeks and 3 months post-HSCT.

Findings

Between August 2014 and January 2016, researchers enrolled 160 of 186 (86%) of potentially eligible patients. At 2 weeks post-HSCT, the inpatient palliative care intervention led to improvements in quality of life, depression, anxiety, and symptom burden. At 3 months post-HSCT, the intervention led to improvements in quality of life, depression, and PTSD. PHQ-9 scores at 2 weeks and HADS-anxiety scores at 3 months did not differ significantly. Please view the scientific abstract for a table of the complete improvements due to the intervention.

Conclusions

Palliative care improved quality of life, depression, anxiety, and symptom burden in patients hospitalized for HSCT, with notable sustained effects 3 months post-HSCT. Involvement of palliative care for patients with hematologic malignancies can improve their outcomes and substantially reduce the morbidity of HSCT.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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