A recent study examined whether inpatient palliative care during hematopoietic stem-cell transplant (HSCT) leads to long-term improvements in quality of life (QoL) and symptom burden for patients, published in the Journal of Clinical Oncology (online September 19, 2017; doi: 10.1200/JCO.2017.73.2800).
Integrating palliative care with transplant care has shown to improve patient QoL and symptom burden during HSCT. However, the long-term effects of integrated palliative care in such patients has yet to be determined.
Areej El-Jawahri, MD, Massachusetts General Hospital, and colleagues conducted a study to assess patients’ mood, post-traumatic stress disorder (PTSD) symptoms, and QoL after a 6-month period following HSCT. A total of 160 patients with hematologic malignancies who underwent autologous or allogeneic HSCT from 2014 to 2016 were randomly assigned to inpatient palliative care integrated with transplant care (n = 81) or transplant care alone (n = 79). Researchers assessed mood, PTSD symptoms, and QoL at baseline and after 6-months post-HSCT by using the Hospital Anxiety and Depression Scale and Patient Health Questionnaire, PTSD checklist, and Functional Assessment of Cancer Therapy-Bone Marrow Transplant. The Edmonton Symptom Assessment Scale was used to determine symptom burden during HSCT.
Intervention effects were evaluated by a covariance analysis while controlling for baseline values. To determine whether symptom or mood during the transplant impacted the effect of palliative care on 6-month outcomes, researchers conducted causal mediation analyses.
After the 6-month follow-up period, patients in the intervention group reported lower depression symptoms on the Hospital Anxiety and Depression Scale and Patient Health Questionnaire (adjusted mean difference, -1.21 and -1.63, respectively) and lower PTSD symptoms (adjusted mean difference, -4.02) than those in the transplant care alone group.
No difference was observed in QoL or anxiety between the care groups. Researchers noted that symptom burden and anxiety during HSCT hospitalization “partially mediated” the effects if intervention on depression and PTSD 6 months after transplant.
Authors of the study concluded that, “By addressing patient symptoms during [HSCT] hospitalization, palliative care clinicians may buffer this highly stressful and potentially traumatic experience, which may partly explain the reduction in psychological distress post-transplant.”—Zachary Bessette