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A new study from MGH has shown that early integration of palliative care services for patients admitted for stem cell transplantation improves quality of life (QOL) and decreases symptoms. Areej El-Jawahri, MD, an MGH oncologist and Director of the MGH Bone Marrow Transplant Survivorship Program, is the lead author of the study. She explains that “hematopoietic stem cell transplantation (HSCT) is an intensive potentially curative therapy for patients with hematologic malignancies.” However, Dr. El-Jawahri also notes that patients undergoing HSCT often experience severe physical and psychological symptoms during their transplant hospitalizations, leading to a significant decline in patients’ QOL and mood. Despite the significant symptom burden experienced by these patients and their potential for a complex treatment course, palliative care services have not traditionally been integrated into the care of patients with hematologic malignances. Dr. El-Jawahri explains that there are many reasons for this, including the uncertainty about prognosis for patients with hematologic malignancies, the tendency for rapid decline at end of life in this population, and misperceptions about palliative care being strictly end-of-life care.
This study enrolled 160 patients with hematologic malignancies admitted for HSCT; patients were randomized to either standard transplant care (with palliative care available upon request), or to integrated palliative and transplant care. Patients in the integrated care group received at least two visits weekly from a palliative care physician or nurse practitioner. Palliative care clinicians focused on symptom management, establishing rapport with patients and families, and promoting coping skills. Assessments regarding QOL, symptom burden, and mood were completed by patients two weeks, three months, and six months after transplant.
Two weeks after transplant, patients in the palliative care intervention group demonstrated improvements in QOL, depression, anxiety, and symptom burden. Dr. El-Jawahri also reports that for patients with palliative care integration during transplant, there was a “sustained improvement in depression and post-traumatic stress three months [after transplant].” These results are “important because this is really the first study showing the benefits of palliative care for patients with hematologic malignancies undergoing curative therapy,” says Dr. El-Jawahri. Overall, researchers concluded that palliative care intervention during admission for HSCT can improve outcomes for patients with hematologic malignancies and reduce the morbidity of HSCT. While there is a need for more studies to better understand the impact of palliative care for this patient population, these are exciting and promising results and we have already seen an increased number of palliative care consult requests from our colleagues in the stem cell transplant unit.
We encourage you to read further about this study using the peer-reviewed publications listed below: