Inpatient Palliative Care During HCT and Psychological Distress After Transplantation

Key Points

  • Compared with transplant care alone, inpatient palliative care integrated with transplant care reduced depression and PTSD symptoms at 6 months after hematopoietic stem cell transplantation.
  • No difference between the two groups was observed for quality of life or anxiety at 6 months.

In a single-center study reported in the Journal of Clinical Oncology, El-Jawahri et al found that inpatient palliative care during hematopoietic stem cell transplantation was associated with improvement in depression and post-traumatic stress disorder (PTSD) symptoms at 6 months after transplantation. A prior report by these investigators found that inpatient palliative care improved quality of life and symptom burden during hematopoietic stem cell transplantation.

Study Details

In the study, 160 patients with hematologic malignancies undergoing allogeneic or autologous hematopoietic stem cell transplantation at Massachusetts General Hospital were randomized between August 2014 and January 2016 to receive inpatient palliative care integrated with transplant care (n = 81) or transplant care alone (n = 79). Mood, PTSD symptoms, and quality of life were assessed with the Hospital Anxiety and Depression Scale and Patient Health Questionnaire, PTSD checklist, and Functional Assessment of Cancer Therapy–Bone Marrow at baseline and 6 months after transplantation. Symptom burden during hematopoietic stem cell transplantation was assessed by the Edmonton Symptom Assessment Scale.

Improvements in Depression and PTSD

At 6 months after transplantation, the intervention group had significantly reduced depression symptoms on the Hospital Anxiety and Depression Scale (adjusted mean difference = –1.21, P = .024) and Patient Health Questionnaire (adjusted mean difference = –1.63, P = .027) and reduced PTSD symptoms (adjusted mean difference = –4.02, P = .013), whereas no difference was observed between groups for quality of life or anxiety. An exploratory analysis indicated that improved symptom burden and anxiety with the intervention during hematopoietic stem cell transplantation hospitalization partially mediated the beneficial effect of the intervention on depression and PTSD at 6 months after transplantation.

The investigators concluded: “Inpatient palliative care integrated with transplant care leads to improvements in depression and PTSD symptoms at 6 months post-transplant. Reduction in symptom burden and anxiety during [hematopoietic stem cell transplantation] partially accounts for the effect of the intervention on these outcomes.”

The study was supported by the National Palliative Care Research Center and the National Cancer Institute.

Areej El-Jawahri, MD, of Massachusetts General Hospital, Harvard Medical School, is the corresponding author of the Journal of Clinical Oncology article. 

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®.


Advertisement

Advertisement



Advertisement