Palliative care integrated with stem cell transplantation improves depression, PTSD symptoms

Integrating palliative care with hematopoietic stem cell transplantation improved symptoms of PTSD and depression among patients with hematologic malignancies, according to the results of a randomized clinical trial.

“Patients who undergo [HSCT] endure substantial physical symptoms as a result of chemotherapy-induced toxicities and early posttransplant complications,” Areej El-Jawahri, MD, instructor of medicine at Harvard Medical School, and colleagues wrote. “These physical symptoms, along with the physical isolation patients experience during the prolonged hospitalization, contribute to a rapid deterioration in quality of life and mood during HSCT.”

Cancer survivors treated with HSCT often experience depression or PTSD from the treatment.

“Despite the short- and long-term burden that HSCT causes patients, interventions to improve their quality of life and reduce their psychological distress are lacking,” the researchers wrote.

El-Jawahri and colleagues randomly assigned 160 patients who had undergone autologous or allogeneic stem-cell transplantation to receive either transplant care alone (n = 79) or inpatient palliative care integrated with transplant care (n = 81). The researchers assessed mood, PTSD symptoms and quality of life at baseline and at 6 months using the Hospital Anxiety and Depression Scale, the PTSD checklist, the Functional Assessment of Cancer Therapy-Bone Marrow Transplant and the Patient Health Questionnaire. El-Jawahri and colleagues also used causal mediation analyses to determine whether burden of symptoms or mood during therapy mediated the effect of the intervention at 6 months.

Six months after transplantation, patients assigned to the palliative care intervention demonstrated lower depression scores (adjusted mean difference, –1.21; 95% CI, –2.26 to –0.16) and lower PTSD symptoms (adjusted mean difference, –4.02; 95% CI, –7.18 to –0.86). However, researchers observed no difference between the two groups for anxiety or quality of life.

Anxiety and symptom burden during treatment partially mediated the effects of palliative care.

“This work demonstrates that involvement of palliative care for patients with hematologic malignancies who undergo HSCT not only improves the patients’ experience during transplantation but also leads to sustained improvement in their depression and PTSD symptoms posttransplant,” the researchers wrote. “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 posttransplant.” – by Andy Polhamus

Disclosures: El-Jawahri reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.