Among patients with hematologic malignancies undergoing hematopoietic stem cell transplantation, the use of inpatient palliative care compared with standard transplant care resulted in a smaller decrease in quality of life two weeks after transplantation, according to a study appearing in the November 22/29 issue of JAMA.
Patients with hematologic malignancies hospitalized for hematopoietic stem cell ("bone marrow") transplantation (HCT) experience physical symptoms due to chemotherapy-induced toxic effects and early post-transplantation complications. These symptoms, along with the physical isolation patients experience during the 3- to 4-week hospitalization, can contribute to a decline in their quality of life (QOL) throughout their hospital stay. Despite the physical and psychological burden experienced by patients undergoing HCT, studies of interventions to improve their QOL and reduce their distress during HCT are limited. Although palliative care clinicians are increasingly asked to care for patients with solid tumors, they are infrequently consulted for patients with hematologic malignancies.
Areej El-Jawahri, M.D., of Massachusetts General Hospital, Boston and colleagues randomly assigned 160 adults with hematologic malignancies undergoing HCT and their caregivers to the intervention (n=81; patients were seen by palliative care clinicians at least twice a week during HCT hospitalization; the intervention was focused on management of physical and psychological symptoms), or standard transplant care (n=79). Patients receiving standard care could be seen by palliative care clinicians on request.
Among the patients (average age, 60 years; 57 percent women), 98 percent completed 2-week follow-up; 93 percent completed 3-month follow-up. The researchers found that intervention patients reported a smaller decrease on measures of QOL from study entry to week 2 vs controls. Also, intervention patients had less increase in depression, lower anxiety, no difference in fatigue, and less increase in symptom burden. At 3 months, intervention patients had higher QOL, lower depression and post-traumatic stress symptoms but no significant differences in anxiety, fatigue, or symptom burden.
From baseline to week 2 after HCT, caregivers of intervention patients vs controls reported no significant differences in QOL or anxiety but had a smaller increase in depression.
"Palliative care may help to lessen the decline in QOL experienced by patients during hospitalization for HCT, which has long been perceived as a natural aspect of the transplantation process," the authors write.
"Further research is needed for replication and to assess longer-term outcomes and cost implications."
(doi:10.1001/jama.2016. 16786; the study is available pre-embargo at the For the Media website)
Editor's Note: This work was supported by funds from the National Palliative Care Research Foundation and a grant from the National Cancer Institute. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.
Related material: Available at the For the Media website, the editorial, "The Promise of Palliative Care," by Preeti N. Malani, M.D., M.S.J., of the University of Michigan Health System, Ann Arbor, and Associate Editor, JAMA, and Eric Widera, M.D., of the University of California, San Francisco.
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