In a study reported in JAMA Oncology, Areej El-Jawahri, MD, and colleagues found that integrated palliative and oncology care was associated with better quality of life vs usual care among patients receiving treatment for acute myeloid leukemia (AML).
The investigators stated, “Patients with AML receiving intensive chemotherapy experience substantial decline in their quality of life and mood during their hospitalization for induction chemotherapy and often receive aggressive care at the end of life. However, the role of specialty palliative care for improving the quality of life and care for this population is currently unknown.”
Areej El-Jawahri, MD
Study Details
In the study, 160 patients undergoing intensive chemotherapy at four U.S. tertiary care hospitals were randomly assigned to receive integrated palliative and oncology care (n = 86) or usual care (n = 74). Data were collected from January 2017 through July 2019. Patients in the integrated palliative and oncology care group were seen by palliative care clinicians at least twice per week during their initial and subsequent hospitalizations.
Quality of life was assessed by the Functional Assessment of Cancer Therapy–Leukemia scale (score range = 0–176), depression and anxiety symptoms by subscales (score range = 0–21) of the Hospital Anxiety and Depression Scale, and posttraumatic stress disorder (PTSD) symptoms by the PTSD Checklist–Civilian version (score range = 17–85) at baseline and weeks 2, 4, 12, and 24. The primary endpoint was quality of life at week 2.
A mixed linear effects model was used to assess the effect of integrated palliative and oncology care on patient-reported outcomes longitudinally across all time points; results were reported using the beta estimated coefficient (β), in which a positive β coefficient indicated a positive association between the intervention and the outcome.
Key Findings
Patients in the integrated palliative and oncology care group had a mean of 2.2 (range = 2–5) visits per week during hospitalization for intensive chemotherapy, whereas 6 patients (8.1%) in the usual care group received a palliative care consultation during their initial hospitalization and 24 (32.4%) had a palliative care consultation during subsequent hospitalizations.
During hospitalization for intensive chemotherapy in the integrated palliative and oncology care group, palliative care clinicians commonly reported establishing rapport (64.9%), addressing symptoms (64.7%), and addressing coping (63.6%) with patients.
KEY POINTS
- At week 2, compared with patients in the usual care group, patients in the integrated palliative and oncology care group reported better quality of life, reduced depression, reduced anxiety, and reduced PTSD symptoms.
- Among patients who died, 21 of 28 in the integrated palliative and oncology care group vs 12 of 30 in the usual care group reported discussing end-of-life care preferences, and 15 of 43 vs 27 of 41 received chemotherapy near the end of life.
At week 2, compared with patients in the usual care group, patients in the integrated palliative and oncology care group reported better quality of life (adjusted mean score = 107.59 vs 116.45, P = .04), reduced depression (adjusted mean score = 7.20 vs 5.68, P = .02), reduced anxiety (adjusted mean score = 5.94 vs 4.53, P = .02), and reduced PTSD symptoms (adjusted mean score = 31.69 vs 27.79, P = .01).
In longitudinal analysis, improvements in the integrated palliative and oncology care vs usual care groups were maintained through week 24 for quality of life (β = 2.35, 95% confidence interval [CI] = 0.02–4.68, P = .048), depression (β = −0.42, 95% CI = −0.82 to −0.02, P = .04), anxiety (β = −0.38, 95% CI = −0.75 to −0.01, P = .04), and PTSD symptoms (β = −1.43, 95% CI = −2.34 to −0.54, P = .002).
Among patients who died, 21 (75%) of 28 in the integrated palliative and oncology care group vs 12 (40%) of 30 in the usual care group reported discussing end-of-life care preferences (P = .01), and 15 (34.9%) of 43 vs 27 (65.9%) of 41 received chemotherapy near the end of life (P = .01).
The investigators concluded, “In this randomized clinical trial of patients with AML, integrated palliative and oncology care led to substantial improvements in quality of life, psychological distress, and end of life care. Palliative care should be considered a new standard of care for patients with AML.”
Dr. El-Jawahri, MD, of Massachusetts General Hospital, is the corresponding author for the JAMA Oncology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
