Palliative care at the time of hematopoietic stem cell transplant (HSCT) can reduce the psychological distress caused by the transplant interventions, a new study published in the Journal of Clinical Oncology. The study found that patients who received palliative care while hospitalized for HSCT experienced a "remarkable and sustained improvement" in depression and posttraumatic stress disorder (PTSD) symptoms 6 months following their transplant.
The single-center study showed dramatic results, so “it needs to be replicated in a multisite study to demonstrate definitively the efficacy of this care model in improving patients quality of life, symptom burden, and psychological outcomes," said lead author Areej El-Jawahri, of Massachusetts General Hospital, Boston. "We also need to get a better understanding of the additional cost of integrating palliative care."
Earlier data from Dr. El-Jawahri and her team, found that at week 2 of hospitalization, palliative care led to statistically significant improvements in QOL, depression, anxiety, and symptom burden in patients undergoing HCT. At 3 months post-transplant, patients had significant improvements in QOL, depression, and symptoms of PTSD.
Another study led by researchers from Johns Hopkins Health System in Baltimore, Maryland, found that in addition to improving quality of care and patient satisfaction, combined inpatient and consultation palliative care programs contributed to substantially lower charges and costs per day, with savings of nearly $4 million a year.
In the current study, the authors investigated long-term effects of inpatient palliative care, integrated with transplant care, on psychological distress and QOL 6 months after transplant. A cohort of 160 patients with hematologic malignancies who underwent autologous or allogeneic HCT were randomly allocated to receive inpatient palliative care integrated with transplant care (n = 81) or standard transplant care alone (n = 79).
At baseline and at 6 months post-transplant, mood, PTSD symptoms, and QOL were evaluated with the Hospital Anxiety and Depression Scale (HADS-D), the nine-item Patient Health Questionnaire (PHQ-9), the Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL), and the Functional Assessment of Cancer Therapy-Bone Marrow Transplant.
At 6 months, patients in the intervention group reported lower depression symptoms, as measured by the HADS-D (adjusted mean difference, 21.21; P = .024) and PHQ-9 (adjusted mean difference, 21.63; P = .027) compared to the control group. The group who received palliative care also reported lower PTSD symptoms (adjusted mean difference, 24.02; P = .013), but anxiety, QOL, and fatigue were not significantly different between the two groups.
Clinically significant depression symptoms were also lower in the palliative care group (HADS-D, 10.14% v 26.40%; P = .017; PHQ-9, 14.29% v 33.33%; P = .010), as were rates of clinically significant PTSD symptoms (PCL, 7.35% v 21.13%; P = .029). In an exploratory analysis, the authors found that symptom burden and anxiety during HCT hospitalization partially mediated the effect of palliative care on depression and PTSD after transplant.
The visibility of palliative care has increased, and its importance is increasingly being studied. "I think the main goal of our study was to really show that palliative care can help patients facing a serious illness regardless of their prognosis," Dr. El-Jawahri said. "In this setting, we see that palliative care can help patients receiving potentially curative therapy."
"In this setting, we see that palliative care can help patients receiving potentially curative therapy," Dr. El-Jawahri concluded. "We are learning that integrating palliative care earlier in the course of illness for patients with cancer and now for those undergoing HCT can lead to improvement in a wide range of patient-reported outcomes and also caregiver outcomes."