Randomized trial of inpatient palliative care in patients hospitalized for hematopoietic stem cell transplantation (HCT).

Authors

null

Areej El-Jawahri

Massachusetts General Hospital, Boston, MA

Areej El-Jawahri, Thomas William LeBlanc, Harry VanDusen, Lara Traeger, Joseph A. Greer, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Yi-Bin Albert Chen, Jennifer S. Temel

Organizations

Massachusetts General Hospital, Boston, MA, Duke University Medical Center, Durham, NC, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, Massachusetts General Hospital, Needham, MA

Research Funding

Other Foundation

Background: During HCT, patients experience physical and psychological symptoms that negatively impact their quality of life (QOL). We assessed the impact of an inpatient palliative care intervention on patient QOL, symptom burden, and mood during HCT hospitalization and at 3 months post-HCT. Methods: We randomized 160 patients with hematologic malignancies admitted for autologous or allogeneic HCT to an inpatient palliative care intervention (n=81) integrated with transplant care compared to transplant care alone (n=79). We used the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) to assess QOL, the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire (PHQ-9) to assess mood, and Edmonton Symptom Assessment Scale (ESAS) to measure symptoms at baseline, week-2, and 3 months post-HCT. We measured post-traumatic stress (PTSD) symptoms using the PTSD checklist at baseline and 3 months post-HCT. We used linear regression models controlling for baseline values to assess the intervention effects on outcomes at week-2 and 3 months post-HCT. Results: Between 8/2014 and 1/2016, we enrolled 160/186 (86%) of potentially eligible patients. At week-2, the intervention led to improvements in QOL, depression, anxiety, and symptom burden. At 3 months post-HCT, the intervention led to improvements in QOL, depression, and PTSD [Table 1]. PHQ-9 scores at week-2 and HADS-anxiety scores at 3 months did not differ significantly. Conclusions: Palliative care improved QOL, depression, anxiety, and symptom burden in patients hospitalized for HCT with notable sustained effects 3 months post-HCT. Involvement of palliative care for patients with hematologic malignancies can improve their outcomes and substantially reduce the morbidity of HCT. Clinical trial information: NCT02207322

Week-2β95% CIP
FACT-BMT7.30.9, 13.90.03
HADS-Depression-1.8-3.0, -0.50.007
HADS-Anxiety-2.3-3.2, -1.3< 0.0001
PHQ-9-1.3-2.8, 0.20.10
ESAS-7.4-13.9, -0.90.03
3 months post-HCTβ95% CIP
FACT-BMT5.30.1, 10.60.048
HADS-Depression-1.7-1.1, -0.70.002
HADS-Anxiety-0.8-1.7, 0.20.13
PHQ-9-2.1-3.4, -0.80.002
PTSD-4.4-7.1, -1.60.002

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Abstract Details

Meeting

2016 Palliative and Supportive Care in Oncology Symposium

Session Type

General Session

Session Title

Welcome and General Session 4: Issues in Caring for Patients with Hematologic Malignancy

Track

Integration and Delivery of Palliative Care in Cancer Care,Biologic Basis of Symptoms and Treatment Toxicities

Sub Track

Models of care delivery

Clinical Trial Registration Number

NCT02207322

Citation

J Clin Oncol 34, 2016 (suppl 26S; abstr 103)

DOI

10.1200/jco.2016.34.26_suppl.103

Abstract #

103

Abstract Disclosures

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