Stem Cell Transplant Patients Benefit From Inpatient Palliative Care

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Palliative care for those with hematologic malignancies undergoing hematopoietic stem cell transplantation improves psychological outcomes.
Palliative care for those with hematologic malignancies undergoing hematopoietic stem cell transplantation improves psychological outcomes.
The following article features coverage from the 2017 American Society of Clinical Oncology Annual Meeting in Chicago, Illinois. Click here to read more of Oncology Nurse Advisor's conference coverage. 

CHICAGO — Inpatient palliative care integrated with hematopoietic stem cell transplantation (HSCT) care is associated with improvements in depression and symptoms of post-traumatic stress disorder (PTSD) at 6 months after transplantation, investigators reported at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting. 

Areej El-Jawahri, MD, of the Massachusetts General Hospital in Boston, and colleagues randomized 160 patients with hematologic malignancies admitted for autologous or allogeneic HSCT to inpatient palliative care intervention integrated with transplant care (81 patients) compared with transplant care alone (79 patients).

At baseline and 6 months post-HSCT, the researchers assessed quality of life (QOL), mood, and PTSD symptoms using the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), the Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire (PHQ-9), and the PTSD checklist, respectively. To assess symptom burden during HCT hospitalization, they used the Edmonton Symptom Assessment Scale.

At 6 months post-HSCT, the intervention led to improvements in depression and PTSD symptoms, but not QOL or anxiety. Compared with the transplant care only group, the intervention group experienced a significantly greater decline in HADS-Depression score (−1.21; 95% CI, −226, −0.16), PHQ-9 score (−1.63; 95% CI, −3.08, −0.19), and PTSD (−4.02; 95% CI, −7.18, −0.86). Improvement in symptom burden during HCT hospitalization partially mediated the effect of the intervention on patient-reported outcomes at 6 months post HSCT, the investigators reported.

“Our work demonstrates that involvement of palliative care for patients with hematologic malignancies undergoing hematopoietic stem cell transplantation not only improves patients' experience during the transplant, but also leads to sustained improvement in patients' long-term psychological outcomes,” Dr El-Jawahri said. “By addressing patients' symptoms during hospitalization for HSCT, palliative care clinicians may buffer the highly stressful and potentially traumatic transplant hospitalization, which may in part explain the reduction in psychological distress posttransplant.”

Read more of Oncology Nurse Advisor's coverage of the 2017 American Society of Clinical Oncology Annual Meeting by visiting the conference page.

Reference

1. El-Jawahri A, Traeger L, VanDusen H, et al. Effect of inpatient palliative care during hematopoietic stem cell transplantation (HCT) hospitalization on psychological distress at six months post-HCT. Oral presentation at: 2017 American Society of Clinical Oncology Annual Meeting; June 2-6, 2017; Chicago, IL.

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