Palliative Care Helpful for Bone Marrow Transplant Patients

Integrating palliative care into the treatment plan of cancer patients undergoing hematopoietic stem cell transplantation (HCT) can improve their quality of life, according to a new study.

Researchers at Massachusetts General Hospital (MGH; Boston, USA), Duke University (Durham NC, USA), and other institutions conducted a randomized clinical trial among 160 adults with hematologic malignancies--such as leukemia and lymphoma--undergoing autologous or allogeneic HCT, in order to assess the effect of inpatient palliative care on patient- and caregiver-reported outcomes during hospitalization for HCT, and 3 months after transplantation.

A total of 81 patients assigned to the intervention were seen by palliative care clinicians at least twice a week during HCT hospitalization; the palliative intervention was focused on management of physical and psychological symptoms. A further 79 patients assigned to standard transplant care could be seen by palliative care clinicians on request. The main outcomes were change in quality of life (QOL) from baseline to two weeks after HCT; patient-assessed mood, fatigue, and symptom burden scores at baseline, two weeks, and three months after HCT; and caregiver-assessed QOL and mood at baseline and two weeks after HCT.

The results indicated significantly better QOL scores for those receiving the palliative care intervention than for the usual treatment group, both at the two-week and the three-month assessments. Patients receiving the palliative care intervention also reported lower levels of depression, anxiety, and physical symptoms at two weeks, and continued to experience less depression, better QOL, and fewer post-traumatic stress symptoms than the control group at three months. Caregivers in the intervention group were also found to have fewer depression symptoms and improved coping skills. The study was published on November 23, 2016, in JAMA.

“Palliative care clinicians are increasingly asked to help care for patients with solid tumors, but are rarely consulted for patients with hematologic malignancies, especially those receiving therapy designed to cure their disease,” said lead author Areej El-Jawahri, MD, director of the bone marrow transplant survivorship program at the MGH Cancer Center. “The physical and psychological symptoms associated with HCT are sometimes regarded as expected and unavoidable, which has contributed to a lack of involvement of palliative care clinicians in the care of these patients.”

Palliative care is a multidisciplinary approach that focuses on providing patients with relief from the symptoms, pain, physical stress, and mental stress of a serious illness, with the goal of improving QOL for both the patient and the family. Palliative care is appropriate at any age and at any stage in a serious illness, and can be provided across multiple settings including in hospitals, in the patient's home, as part of community palliative care programs, and in skilled nursing facilities.

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Massachusetts General Hospital
Duke University