Patients undergoing bone marrow transplants (HCT) to treat blood cancers such as lymphoma or leukemia may benefit from palliative care during their time in the hospital, according to a new study.
The authors show that these patients have better quality of life, relief from symptoms, and less depression and anxiety than patients who receive standard care, and that these benefits extend for several months after the cancer treatment.
The study, “Effect Of Inpatient Palliative Care On Quality Of Life 2 Weeks After Hematopoietic Stem Cell Transplantation – A Randomized Clinical Trial,” was published in the journal JAMA.
“Palliative care clinicians are increasingly asked to help care for patients with solid tumors, but are rarely consulted for patients with hematologic malignancies, especially those receiving therapy designed to cure their disease,” Areej El-Jawahri, MD, the lead author of the study, said in a news release.
“The physical and psychological symptoms associated with HCT are sometimes regarded as expected and unavoidable, which — combined with the persistent misperception that equates palliative care with end-of-life care — has contributed to a lack of involvement of palliative care clinicians in the care of these patients.”
Bone marrow transplants (HCT) start with high-dose chemotherapy and/or radiation therapy to remove cancer cells from the body. Then an infusion of blood stem cells is transplanted into the patient to replenish the body with healthy blood cells. During this time – about three or four weeks in the hospital – patients often experience severe side effects from the chemotherapy, such as pain, vomiting and fatigue, and have limited contact with visitors to avoid possible infections.
Taken together, this demanding experience may increase symptoms of depression and anxiety and have a negative impact on the patient’s quality of life.
Researchers followed 160 patients who received HCT treatment for different blood malignancies at Massachusetts General Hospital (MGH) from August 2014 to January 2016. Patients were randomly assigned to receive either palliative care or the standard of care.
Patients who received palliative care started getting it within three days after their admission to the hospital and received about eight sessions during their hospital stay (on average 21 days).
At each session, in which family or friend caregivers could be present, a palliative care clinician worked on building a mutual trust relationship with the patients and addressed their physical and psychological needs while providing support and strategies to help them cope with their stressful experience.
Two weeks after the start of palliative care, patients reported a better quality of life than those in the standard care group, meeting the study’s primary endpoint. They also had lower depression, anxiety, and symptom burden by that time, compared to the control group.
Three months after HCT treatment, patients who had received palliative care still had a higher quality of life and fewer symptoms of depression than the other patients, although no differences were found regarding fatigue, anxiety, or symptom burden.
In 42 percent of the palliative care sessions, family members or friend caregivers were present. Researchers asked them to fill out questionnaires on their own experience as caregivers, and found that from baseline to week 2 after HCT, caregivers of patients who received palliative care were less depressed and had improved coping skills compared to caregivers of patients included in the control group.
“Caregivers play a crucial role in supporting patients during the transplant process, and they are substantially impacted as they watch their loved ones struggle with side effects that can be emotionally challenging,” El-Jawahri said.
“An important aspect of this study is its extension of the benefits of palliative care beyond patients with advanced solid tumors to those receiving curative therapy for hematologic malignancies,” said Jennifer Temel, the senior author of the study. “Our results highlight how palliative care can be beneficial for patients with cancer regardless of their prognosis.”
But the researchers note that more studies are needed in larger and more diverse groups to confirm the benefits of including palliative care in the treatment of patients with blood cancers.
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