Palliative care improves quality of life for recipients of bone marrow transplantation
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Palliative care significantly improved quality of life among patients hospitalized for bone marrow transplant, according to results of a multicenter randomized trial.
Palliative care also reduced fatigue and depression, findings presented at Annual Assembly of American Academy of Hospice and Palliative Medicine showed.
Researchers enrolled 360 adults undergoing bone marrow transplantation at Duke University Hospital, Massachusetts General Hospital and Fred Hutchinson Cancer Center.
Half of the cohort participated in a palliative care intervention that monitored symptom management, quality of life, depression and anxiety, fatigue, coping and PTSD symptoms. The other half received usual care.
Those in the intervention group reported better quality of life, characterized by the extent of a patient’s health, comfort and ability to engage in life events. Patients who received the intervention also experienced lower levels of depression, PTSD and fatigue.
“This multisite, randomized clinical trial provides a very high level of evidence confirming the benefit of integrated specialist palliative care for patients hospitalized to undergo [hematopoietic stem cell transplantation],” trial co-investigator Thomas LeBlanc, MD, a hematologic oncologist and chief patient experience and safety officer for Duke Cancer Institute, told Healio. “These findings are practice-changing, such that integrative palliative care should be considered a new standard of care as part of the transplant process.”
Healio spoke with LeBlanc about the impact transplant has on quality of life and how the intervention evaluated in this trial improved outcomes.
Healio: What prompted you to study this topic?
LeBlanc: We know patients undergoing hematopoietic stem cell transplantation face significant hardships during the transplant process itself, and also in the longer term. Yet, standard transplant care may not be providing enough support to address these issues optimally. The integration of specialist palliative care into various aspects of cancer care has been shown to improve the patient experience of treatment, so we had reason to think that integrating palliative care specialists into the transplant process could help patients undergoing HSCT, too. More specifically, we hoped this intervention would improve symptom burden and quality of life, while reducing anxiety and depression symptoms, and also the risk for PTSD in the longer term.
Healio: What are some of the quality-of-life issues transplant recipients face?
LeBlanc: Patients undergoing HSCT suffer a significant symptom burden from the transplant process. Some of this stems from the preparative chemotherapy or radiation therapy, which causes low blood counts, fatigue, nausea/vomiting, bowel issues, insomnia, mouth sores or “mucositis,” and infections, among other things. They require a lot of support during the several-weeks-long hospitalization that is usually required in the HSCT process. Evidence shows these patients face an enormous burden of bothersome symptoms during that hospital stay, along with a large decrement in quality of life, significant anxiety and depression symptoms, and even longer-term post-traumatic stress symptoms.
Healio: How did you conduct this study?
LeBlanc: We approached and enrolled patients — and willing caregivers — to this randomized trial at the time of hospital admission for HSCT at three diverse cancer centers with established transplant programs. These included Duke Cancer Institute, Fred Hutchinson Cancer Center and Massachusetts General Hospital, which was the lead, coordinating center under investigator Areej El-Jawahri, MD. Upon enrollment, 360 patients were randomly assigned 1:1 to the intervention arm or the standard transplant care arm. Those in the intervention arm were seen by a specialist palliative care clinician at least twice per week during their hospital stay for transplant. The intervention focused on symptoms, quality of life, anxiety and depression, coping, and management of stress and distress. Interventionists were either trained nurse practitioners and physician assistants, or MD palliative care clinicians.
Healio: What did you find?
LeBlanc: We found impressive improvements in the patient experience of HSCT. Patients receiving the palliative care intervention reported better quality of life, as well as lower depression, PTSD and fatigue symptoms compared with those receiving usual care. Anxiety did not differ significantly between the two groups of patients, but patients receiving the intervention had fewer PTSD symptoms 6 months after transplant. Interestingly, although there was no direct caregiver component of the intervention, the caregivers of patients receiving palliative care had reduced anxiety symptoms during the transplant hospitalization, as well.
Healio: What questions or challenges remain in this area?
LeBlanc: The remaining challenge is to implement this model of care at all transplant centers, some of which may not have a sufficient palliative care workforce to conduct this intervention.
Reference:
- Duke Health. Palliative care improves quality of life for bone marrow transplant patients (press release). Available at: https://corporate.dukehealth.org/news/palliative-care-improves-quality-life-bone-marrow-transplant-patients. Posted March 25, 2024. Accessed April 16, 2024.
For more information:
Thomas LeBlanc, MD, can be reached at thomas.leblanc@duke.edu.
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