Palliative Care During In-Patient HSCT Improves Quality of Life, Reduces Depression

Palliative care may be an effective strategy to improve quality of life (QOL) for patients who are hospitalized while undergoing hematopoietic stem cell transplantation (HSCT), according to a study presented at the ASH Annual Meeting 2023.

Patients undergoing HSCT in the hospital tend to experience a drastic decline in QOL and an increase in psychological distress; therefore, a group of researchers conducted a multisite randomized trial to explore the efficacy of using a palliative care model in hospitalized patients undergoing HSCT.

The experience and burden of HSCT hospitalization is predictive of long-term QOL impairment, depression, and posttraumatic stress symptoms, noted presenter Areej El-Jawahri, MD, but supportive care options are limited. 

Single-care studies have shown that using palliative care to improve QOL and psychological distress in these patients is feasible. But this team sought to test the efficacy of palliative care integration across diverse care settings. 

The research team enrolled 360 adult patients with hematologic malignancies undergoing HSCT at 3 different academic medical centers. Patients were randomly assigned to an inpatient palliative care intervention (n=180) or to a usual care transplant model (n=180), stratified by study site and the type of HCST. The groups were relatively balanced when it came to disease and transplant-related characteristics. 

The patients assigned to the intervention arm visited with a palliative care physician at least twice weekly. Those in the standard care arm could ask for palliative care if they chose.

Outcomes data for the primary endpoint of QOL were gathered at week 2 from 173 (96.1%) patients in the intervention arm and 160 (88.9%) in the usual care arm. Week 2 of hospitalization tends to be the nadir for patients in terms of QOL and psychological distress, as hospitalization is the traumatic event that palliative care seeks to mitigate, explained Dr El-Jawahri. (Three- and 6-month post-HSCT data will be reported at a later date.)

“Our hope is that by intervening on that acute trauma, we can actually improve long-term outcomes, including quality of life and psychological distress,” said Dr El-Jawahri. 

Data revealed the intervention group experienced a better QOL at week 2 compared with the group receiving standard care (95.5 vs 89.3; P <.001). They experienced less depression symptoms (5.9 vs 6.9; P =.041) and a much lower incidence of PTSD symptoms (26.0 vs 28.2; P =.022). 

Symptom burden (35.3 vs 40.1; P =.018) and fatigue scores (28.6 vs 25.6; P =.014) were also lower in the intervention group compared with the usual care group. However, no statistically significant difference in anxiety was reported between the 2 groups.

“In summary, specialty palliative care integrated with stem cell transplant improved patient-reported quality of life, symptom burden, fatigue, depression, and posttraumatic stress symptoms acutely during the transplant hospital stay,” said Dr El-Jawahri, noting that the findings ensure generalizability across care settings. 

Future research should delve into better understanding of the mechanism by which palliative care improves the lived experienced of patients undergoing HSCT. Additionally, clinicians should consider how to scale this care model to ensure the delivery of high-quality supportive care for hospitalized patients undergoing HSCT in the hospital, Dr El-Jawahri concluded. 

Reference

El-Jawahri A, LeBlanc TW, Kavanaugh A, et al. Multi-site randomized trial of inpatient palliative care for hospitalized patients undergoing hematopoietic stem cell transplantation. Presentation at ASH 2023. December 9-12, 2023. San Diego, CA. Abstract 913.