Effect of inpatient palliative care on quality of life 2weeks after hematopoietic stem cell transplantation: A randomized clinical trial

Abstract

IMPORTANCE During hospitalization for hematopoietic stem cell transplantation (HCT), patients receive high-dose chemotherapy before transplantation and experience significant physical and psychological symptoms and poor quality of life (QOL). OBJECTIVE To assess the effect of inpatient palliative care on patient- and caregiver-reported outcomes during hospitalization for HCT and 3 months after transplantation. DESIGN, SETTING, AND PARTICIPANTS Nonblinded randomized clinical trial among 160 adults with hematologic malignancies undergoing autologous/allogeneic HCT and their caregivers (n = 94). The study was conducted from August 2014 to January 2016 in a Boston hospital; follow-up was completed in May 2016. INTERVENTIONS Patients assigned to the intervention (n=81) were seen by palliative care clinicians at least twice a week during HCT hospitalization; the palliative intervention was focused on management of physical and psychological symptoms. Patients assigned to standard transplant care (n=79) could be seen by palliative care clinicians on request. MAIN OUTCOMES AND MEASURES Primary: change in patientQOLfrom baseline toweek 2; secondary: patient-assessedmood,fatigue, and symptomburden scores at baseline, 2weeks, and 3 months after HCT and caregiver-assessedQOLandmoodat baseline and 2weeks after HCT. RESULTS Among160patients(meanage,60[SD, 13.3] years;91women[56.9%];medianhospital stay,21days)and94caregivers,157(98.1%)and89(94.7%),respectively,completed2-weekfollowup, and149patients(93.1%)completed3-monthfollow-up.Interventionpatientsreportedasmaller decrease inQOLfrom baseline toweek 2 vs controls. Intervention patients had less increase in depression,loweranxiety,nodifferenceinfatigue,andlessincreaseinsymptomburden.At3months, intervention patients had higherQOLand less depression but no significant differences in anxiety, fatigue,or symptomburden.Frombaseline toweek2afterHCT, caregivers of intervention patients vs controls reported no significant differences inQOLor anxiety but had a smaller increase in depression (mean,0.25 vs 1.80; mean difference, 1.55; 95%CI,0.14-2.96; P = .03). (Table Presented) CONCLUSIONS AND RELEVANCE Among adults at a single institution undergoing HCT for hematologic malignancy, the use of inpatient palliative care compared with standard transplant care resulted in a smaller decrease in QOL 2 weeks after transplantation. Further research is needed for replication and to assess longer-term outcomes and cost implications.