Palliative Care Improves QOL During Transplant for Hematologic Malignancies

The use of inpatient palliative care services among adult patients undergoing hematopoietic stem cell transplantation (HCT) for a hematologic malignancy results in smaller decreases in quality-of-life outcomes compared with standard transplant care, according to the results of a single-institution study published in JAMA.

“Exploratory secondary outcomes also showed that patients in the palliative care group benefited, with less increase in their depression symptoms, lower anxiety symptoms, and less increase in symptom burden compared with those receiving standard transplant care,” wrote researchers led by Areej El-Jawahri, MD, of Massachusetts General Hospital. “Thus, 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.”

Undergoing transplantation for hematologic malignancies is associated with significant physical and psychological symptoms and poor quality of life. In this study, El-Jawahri and colleagues assessed the use of inpatient palliative care on patient- and caregiver-reported outcomes during hospitalization for transplant and at 3 months post-transplant.

The study included 160 adults with a hematologic malignancy undergoing transplant and their caregivers (n = 94). Patients were randomly assigned to the palliative care arm or to standard transplant care. The palliative care intervention meant meeting with a palliative care clinician at least twice a week during transplant hospitalization. The primary outcome was change in patient quality of life from baseline to 2 weeks.

“To our knowledge, this is the first study to evaluate the effect of a palliative care intervention for patients receiving potentially curative therapy, specifically those with hematologic malignancies hospitalized for HCT,” the researchers wrote.

Of the enrolled patients and caregivers, 157 patients and 89 caregivers completed the 2-week follow-up, and 149 patients completed the 3-month follow-up.

Those patients who were assigned to receive palliative care reported a smaller decrease in quality of life from baseline to 2 weeks compared with control patients (–14.72 vs –21.54; P = .045). Being seen by a palliative care clinician also significantly improved symptom burden scores (17.35 vs 23.14; P = .03), depression scores (2.43 vs 3.92; P = .02), and anxiety (–0.80 vs 1.12; P < .001) at 2 weeks compared with patients assigned to standard care.

“In the present study, only 2 patients randomized to receive standard transplant care received a palliative care consultation, illustrating the infrequent use of palliative care in this population,” the researchers wrote. “This study also suggests that the benefits of palliative care may extend beyond patients with solid tumors.”

At the 3-month follow-up, patients assigned to the intervention had higher quality-of-life scores and less depression than patients assigned standard care, but there were no significant differences in anxiety, fatigue, or symptom burden.

Interestingly, at 2 weeks caregivers of patients assigned to the intervention had a smaller increase in depression compared with caregivers of control patients (P = .03). However, there were no differences in quality of life or anxiety for these caregivers.

“Although this study was underpowered to examine caregiver outcomes, the palliative care intervention led to improvements in caregivers’ coping and depression symptoms at 2 weeks but no significant improvement in caregivers’ QOL or anxiety symptoms,” the researchers wrote. “These findings suggest that modifying patients’ experience during HCT may have some positive effects on some aspects of caregivers’ well-being.”

In an editorial that accompanied the study, Preeti N. Malani, MD, MSJ, of the University of Michigan Health System, and Eric Widera, MD, of the University of California, San Francisco, wrote, “Studies such as that of El-Jawahri et al help define the broader clinical potential of palliative care, which remains a dynamic and evolving field. In particular, the results provide additional evidence that palliative care should not be restricted to the end of life.”

Drs. Malani and Widera added: “The integration of specialized palliative care teams into usual clinical care should be adopted as part of an updated standard of care, similar to the routine involvement of pharmacy, nutrition, and social work.”