Palliative Care Improves Quality of Life, Mood for Patients With Cancer Undergoing Stem Cell Transplant

Palliative care can improve quality of life for patients hospitalized for hematopoietic stem cell transplantation (HCT), according to a study presented at the American Society of Clinical Oncology's (ASCO) 2016 Palliative Care in Oncology Symposium in San Francisco September 9-10.

“Hematopoietic stem cell transplantation is an intensive potentially curative therapy for patients with hematologic malignancies”, said Areej El-Jawahri, M.D., lead author on the study during the presentation. “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 people received inpatient palliative care intervention integrated with transplant care compared with the other group, 79 people, who received transplant care alone.

During integrated palliative and transplant care, patients had at least two 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 two after transplant, then again at three months post-HCT. The six-month assessment results have not yet been revealed.

The researchers from Massachusetts General Hospital Cancer Center and Cancer Outcomes Research 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 two and three months post-HCT. Post-traumatic stress (PTSD) symptoms were measured using the PTSD checklist at baseline and three months post-HCT.

At week two, there were improvements in quality of life, depression, anxiety and symptom burden in the intervention group. At three-months, the intervention led to improvements in quality of life, depression and PTSD.

Median age, gender, race did not vary drastically among patients participating in the study. Most participants were white, female and over 50 years of age.

“Palliative care physicians were asked to document what they focused on during the palliative care visits and during the initial consultation visit,” said El-Jawahri. “Predominantly they focused on symptoms, establishing rapport with patients and families, as well as coping. When it comes 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 after three 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.

She urged for more multi-site randomized controlled trials to definitely demonstrate the efficacy of the care model for patients hospitalized for HCT. Future studies are now needed, according to El-Jawahri, to evaluate the impact of early integration for this population on illness understanding and end-of-life outcomes.