SAN FRANCISCO ― Palliative care is generally associated with terminal illness, but a new study shows that it that it can improve outcomes for those undergoing curative therapy.
Among patients undergoing autologous or allogeneic hematopoietic stem cell transplantation (HCT), palliative care improved outcomes and substantially reduced the morbidity associated with HCT.
"This is the first study showing the benefit in curative therapy and in hematopoietic stem cell transplantation," said lead author Areej El-Jawahri, MD, of Massachusetts General Hospital, Boston.
"At 3 months post transplant, the intervention still led to an increase in quality of life, and it was statistically significant," explained Dr El-Jawahri, who presented the findings of her study at the Palliative Care in Oncology Symposium (PCOS) 2016. "This is a relatively brief intervention that led to a remarkable sustained improvement in depression and posttraumatic stress 3 months later, after transplantation."
As compared with patients who received standard transplant care, palliative care improved quality of life (QOL), depression, anxiety, and symptom burden.
Commenting on the study, Candice A. Johnstone, MD, MPH, associate professor of radiation oncology at the Medical College of Wisconsin, Milwaukee, believes that this study is "truly groundbreaking."
"We have an image problem in palliative care, and a good majority of people associate palliative care with hospice and death," she told Medscape Medical News. "This is the first study to show that people benefit from palliative care in the curative setting — which means that they can benefit from palliative care in all settings."
Data are needed to prove that, Dr Johnstone added, "but the point is that palliative care and supportive care support everyone through the illness trajectory. And that is what is truly groundbreaking about this study."
In the randomized trial, patients in the intervention group had at least four palliative care visits during their hospitalization. The median number of visits was eight. The primary areas that were addressed were symptoms (88.9% of visits); rapport building and establishing relationship with patients and families (98.8%); and helping patients and families cope with the illness (85.2%).
Reduces Symptoms, Improves QOL
Palliative care has been shown to improve the QOL in cancer patients with solid tumors, but it is rarely provided to those with hematologic malignancies.
In this study, Dr El-Jawahri and her colleagues 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.
They found that at week 2 of hospitalization, the intervention had led to statistically significant improvements in QOL, depression, anxiety, and symptom burden. At 3 months post HCT, the intervention had led to significant improvements in QOL, depression, and symptoms of posttraumatic stress disorder (PTSD) (see tables below).
HCT is associated with both physical and psychological symptoms that have a negative effect on QOL.
A total of 160 patients with hematologic malignancies who were to undergo autologous or allogeneic HCT were admitted to an inpatient palliative care intervention (n = 81) that was integrated with transplant care. Outcomes for these patients were compared with those of patients who received standard transplant care alone (n = 79).
The majority of patients had been diagnosed with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). Other patients had been diagnosed with lymphoma or multiple myeloma.
Roughly half of all patients in both cohorts underwent autologous HCT.
The authors used the Functional Assessment of Cancer Therapy–Bone Marrow Transplant (FACT-BMT) to assess QOL; the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire (PHQ-9) to assess mood; and the Edmonton Symptom Assessment Scale (ESAS) to measure symptoms at baseline, at 2 weeks, and at 3 months post HCT.
PTSD symptoms were measured using the PTSD checklist at baseline and at 3 months post HCT.
"Patients randomized to palliative care had at least two visits per week by a palliative care specialist during hospitalization; those who were randomized to transplant care alone could also request palliative care," said Dr El-Jawahri.
She pointed out that the primary endpoint of the study was focused on week 2, which is the period when patients experience the highest symptom burden and deterioration of QOL.
"Our hypotheses were that patients receiving palliative care would experience less deterioration of quality of life and less symptom burden," she said.
Table 1. Patient Outcomes at 2 Weeks
| Measure Used | Mean Adjusted Difference | P Value |
| FACT-BMT | 7.73 | .02 |
| FACT fatigue | 3.88 | .04 |
| HADS depression symptoms | -1.74 | .008 |
| HADS anxiety symptoms | -2.26 | <.001 |
| PHQ-9 depression symptoms | -1.28 | .104 |
| ESAS symptom burden | -6.26 | .019 |
Table 2. Patient Outcomes at 3 Months
| Measure Used | Mean Adjusted Difference | P Value |
| FACT-BMT | 5.34 | .048 |
| FACT fatigue | 2.00 | .202 |
| HADS depression symptoms | -1.70 | .002 |
| HADS anxiety symptoms | -.76 | .130 |
| PHQ-9 depression symptoms | -2.12 | .002 |
| ESAS symptom burden | -4.35 | .0002 |
Further research is needed to evaluate palliative care interventions targeted to the needs of patients with hematologic malignancies, Dr El-Jawahri concluded.
Dr El-Jawahri and Dr Johnstone have disclosed no relevant financial relationships.
Palliative Care in Oncology Symposium (PCOS) 2016. Abstract 103. Presented September 10, 2016.
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Cite this: 'Groundbreaking' Palliative Care Study: Not Just for Dying - Medscape - Sep 13, 2016.
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