Nav: Home

Palliative care has beneficial effect on quality of life following stem cell transplantation

November 22, 2016

Among patients with hematologic malignancies undergoing hematopoietic stem cell transplantation, the use of inpatient palliative care compared with standard transplant care resulted in a smaller decrease in quality of life two weeks after transplantation, according to a study appearing in the November 22/29 issue of JAMA.

Patients with hematologic malignancies hospitalized for hematopoietic stem cell ("bone marrow") transplantation (HCT) experience physical symptoms due to chemotherapy-induced toxic effects and early post-transplantation complications. These symptoms, along with the physical isolation patients experience during the 3- to 4-week hospitalization, can contribute to a decline in their quality of life (QOL) throughout their hospital stay. Despite the physical and psychological burden experienced by patients undergoing HCT, studies of interventions to improve their QOL and reduce their distress during HCT are limited. Although palliative care clinicians are increasingly asked to care for patients with solid tumors, they are infrequently consulted for patients with hematologic malignancies.

Areej El-Jawahri, M.D., of Massachusetts General Hospital, Boston and colleagues randomly assigned 160 adults with hematologic malignancies undergoing HCT and their caregivers to the intervention (n=81; patients were seen by palliative care clinicians at least twice a week during HCT hospitalization; the intervention was focused on management of physical and psychological symptoms), or standard transplant care (n=79). Patients receiving standard care could be seen by palliative care clinicians on request.

Among the patients (average age, 60 years; 57 percent women), 98 percent completed 2-week follow-up; 93 percent completed 3-month follow-up. The researchers found that intervention patients reported a smaller decrease on measures of QOL from study entry to week 2 vs controls. Also, intervention patients had less increase in depression, lower anxiety, no difference in fatigue, and less increase in symptom burden. At 3 months, intervention patients had higher QOL, lower depression and post-traumatic stress symptoms but no significant differences in anxiety, fatigue, or symptom burden.

From baseline to week 2 after HCT, caregivers of intervention patients vs controls reported no significant differences in QOL or anxiety but had a smaller increase in depression.

"Palliative care may help to lessen the decline in QOL experienced by patients during hospitalization for HCT, which has long been perceived as a natural aspect of the transplantation process," the authors write.

"Further research is needed for replication and to assess longer-term outcomes and cost implications."
-end-
(doi:10.1001/jama.2016. 16786; the study is available pre-embargo at the For the Media website)

Editor's Note: This work was supported by funds from the National Palliative Care Research Foundation and a grant from the National Cancer Institute. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.

Related material: Available at the For the Media website, the editorial, "The Promise of Palliative Care," by Preeti N. Malani, M.D., M.S.J., of the University of Michigan Health System, Ann Arbor, and Associate Editor, JAMA, and Eric Widera, M.D., of the University of California, San Francisco.

To place an electronic embedded link to this study in your story This link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2016.16786

The JAMA Network Journals

Related Palliative Care Articles:

Prediction system significantly increases palliative care consults
A trigger system powered by predictive analytics increased palliative care consultations by 75 percent after its implementation
Early palliative care for advanced lung cancer increases survival
Early palliative care is associated with better survival in patients with advanced lung cancer, according researchers with the Veterans Affairs Portland Health Care System and Oregon Health and Science University.
New staffing model for an integrated specialist team approach to palliative care
The Canadian Society of Palliative Care Physicians has developed a new staffing model for specialist palliative care teams that can deliver an optimal, integrated palliative care program.
Unique case of cannabis hyperemesis syndrome in palliative care
The medical use of cannabis is growing. Medical marijuana may improve symptoms including pain and anorexia.
Site of care may affect patients' access to palliative treatment
Studies have found that racial and ethnic minorities are less likely to receive end-of-life palliative care than their counterparts.
Best practices in palliative care supported by growing evidence base, study finds
Best practices in the growing field of palliative care have been created on several occasions based upon consensus among experts.
Palliative care may reduce suicide risk in veterans with lung cancer
New research finds patient care focused on relieving symptoms, stress reduces suicide risk by 81 percent
Palliative care improves hospital care for seriously ill patients
Palliative care provided by specialist medical and nursing teams to patients with complex health needs significantly improves their experience of care, new research shows.
Provide stroke patients with palliative care support minus the label
When caring for stroke patients, health care providers should focus on the social and emotional issues facing patients, rather than only physical rehabilitation, according to a new study published in CMAJ (Canadian Medical Association Journal).
Early access to palliative care associated with better quality of life
Patients with advanced cancer have a significantly better quality of life in the weeks before they die if they receive early access to palliative care, according to research published today.
More Palliative Care News and Palliative Care Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Risk
Why do we revere risk-takers, even when their actions terrify us? Why are some better at taking risks than others? This hour, TED speakers explore the alluring, dangerous, and calculated sides of risk. Guests include professional rock climber Alex Honnold, economist Mariana Mazzucato, psychology researcher Kashfia Rahman, structural engineer and bridge designer Ian Firth, and risk intelligence expert Dylan Evans.
Now Playing: Science for the People

#540 Specialize? Or Generalize?
Ever been called a "jack of all trades, master of none"? The world loves to elevate specialists, people who drill deep into a single topic. Those people are great. But there's a place for generalists too, argues David Epstein. Jacks of all trades are often more successful than specialists. And he's got science to back it up. We talk with Epstein about his latest book, "Range: Why Generalists Triumph in a Specialized World".
Now Playing: Radiolab

Dolly Parton's America: Neon Moss
Today on Radiolab, we're bringing you the fourth episode of Jad's special series, Dolly Parton's America. In this episode, Jad goes back up the mountain to visit Dolly's actual Tennessee mountain home, where she tells stories about her first trips out of the holler. Back on the mountaintop, standing under the rain by the Little Pigeon River, the trip triggers memories of Jad's first visit to his father's childhood home, and opens the gateway to dizzying stories of music and migration. Support Radiolab today at Radiolab.org/donate.