Palliative care significantly improved the quality of life of patients hospitalized for bone marrow transplantation, according to the results of a multicenter randomized trial.
Palliative care also reduced fatigue and depression, according to the study findings presented at the annual meeting of the American Academy of Hospice and Palliative Medicine.
The researchers enrolled 360 adults undergoing bone marrow transplants at Duke University Hospital, Massachusetts General Hospital, and Fred Hutchinson Cancer Center.
Half of the cohort participated in a palliative care intervention monitoring symptom management, quality of life, depression and anxiety, fatigue, coping, and PTSD symptoms, while the other half received usual care.
Patients in the intervention group reported a better quality of life, characterized by the patient's degree of health, comfort, and ability to cope with life's events. Patients who received the intervention also had lower levels of depression, PTSD, and fatigue.
“This multicentre randomised clinical trial provides a very high level of evidence confirming the benefits of integrated specialist palliative care for patients during hospitalisation. [hematopoietic stem cell transplantation]”, Clinical trial co-researcher Thomas LeBlanc, MD John F. Kennedy, a hematologist-oncologist and chief of patient experience and safety at Duke Cancer Institute, told Healio, “These findings are practice-changing, and integrative palliative care should be considered as a new standard of care as part of the transplant process.”
Healio spoke with LeBlanc about the impact of transplant on quality of life and how the interventions evaluated in the trial improved outcomes.
Helio: What was the trigger? To Would you like to study this topic?
LeBlanc: We know that patients undergoing hematopoietic stem cell transplants face significant challenges, not only during the transplant process itself, but also in the long term. However, standard transplant care may not provide enough support to optimally address these challenges. We know that incorporating specialist palliative care into various aspects of cancer treatment improves patients' experience of treatment, so we had reason to believe that incorporating palliative care experts into the transplant process could also help patients undergoing hematopoietic stem cell transplants. More specifically, we hoped that this intervention would improve symptom burden and quality of life, reduce anxiety and depression, and in the long term, reduce the risk of PTSD.
Healio: What quality of life issues are there after transplant? Receiver face?
LeBlanc: Patients undergoing HSCT suffer a significant symptom burden from the transplant process, some of which stems from preparatory chemotherapy or radiation therapy, resulting in low blood counts, fatigue, nausea/vomiting, bowel problems, insomnia, mouth sores or “mucositis”, infections, and more. They require a lot of support during the several weeks of hospitalization that the HSCT process typically requires. Evidence suggests that these patients face a significant burden of bothersome symptoms during hospitalization, with significantly reduced quality of life, pronounced anxiety and depression, as well as long-term post-traumatic stress symptoms.
Healio: How was this study conducted?
LeBlanc: We enrolled patients and supportive caregivers in this randomized trial at the time of admission for HSCT at three cancer centers with established transplant programs, including Duke Cancer Institute, Fred Hutchinson Cancer Center, and Massachusetts General Hospital, which was the lead coordinating center under the investigators. Areej El JawaliMarylandAt enrollment, 360 patients were randomly assigned 1:1 to receive either the intervention or standard transplant care. Patients in the intervention group were seen by a specialized palliative care clinician at least twice weekly during their hospitalization for transplant. The intervention focused on managing symptoms, quality of life, anxiety and depression, coping, and stress and distress. Interventionists were trained nurses and physician assistants or MD palliative care clinicians.
Helio: What? you search?
LeBlanc: There were notable improvements in the patient experience of HSCT. Patients who received the palliative care intervention reported better quality of life and reduced symptoms of depression, PTSD, and fatigue compared to patients who received usual care. Anxiety did not differ significantly between the two patient groups, but patients who received the intervention had fewer PTSD symptoms 6 months after transplant. Interestingly, although there was no direct caregiver component to the intervention, caregivers of patients who received palliative care also experienced reduced anxiety symptoms during their transplant hospitalization.
Healio: What is your question? or Are there challenges remaining in this area?
LeBlanc: The challenge remains to implement this model of care in all transplant centers, some of which may not have sufficient palliative care personnel to implement this intervention.
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For more information:
Thomas LeBlanc, medical doctor, Please contact me at [email protected].
