El-Jawahri, A., LeBlanc, T., VanDusen, H., Traeger, L., Greer, J.A., Pirl, W.F., . . . Temel, J.S. (2016). Effect of inpatient palliative care on quality of life 2 weeks after hematopoietic stem cell transplantation: A randomized clinical trial. JAMA, 316, 2094–2103.

To assess the impact of palliative care interventions on symptoms and quality of life among patients undergoing HCT

Within 72 hours of transplant admission, patients were randomized to treatment and control groups. Within 72 hours of group assignment, patients in the palliative care group met with the palliative care physician or advanced practice nurse for planning management of symptoms. Palliative interventions were provided according to guidelines in a manual developed for addressing pharmacologic and non-pharmacologic symptom management interventions. Study measures were obtained at baseline and during the second week of hospitalization, day 5 after autologous cell infusion, day 8 after allogeneic HCT, and at 3 and 6 months after HCT.

• N = 157    
• AGE: Mean = 57.05 years
• MALES: 42%  
• FEMALES: 58%
• CURRENT TREATMENT: Combination radiation and chemotherapy
• KEY DISEASE CHARACTERISTICS: Most had autologous HCT
• OTHER KEY SAMPLE CHARACTERISTICS: Most had college or more formal education. More than 70% were married.

• SITE: Single site   
• SETTING TYPE: Inpatient    
• LOCATION: Massachusetts

• PHASE OF CARE: Transition phase after active treatment
• APPLICATIONS: Palliative care

RCT

• FACT-BMT
• FACT Fatigue score
• PHQ9 for depression
• Hospital Anxiety and Depression Scale
• Edmonton Symptom Assessment Scale (ESAS)

Hospitalization lasted an average of 21 days, ranging from 12-102.  Most commonly addressed symptoms were nausea, pain, diarrhea, and constipation. At two weeks, BMT scores (p = 0.02), fatigue scores (p = 0.04) ESAS symptoms burden scores (p = 0.02), and HADs anxiety and depression subscales (p < 0.008) were all better in the palliative care group. At three months, depression scores were lower in the palliative care group (p = 0.002). HADs scores, however, did not show clinically relevant levels of anxiety or depression. At three months, there was no difference between groups in fatigue, anxiety, or overall symptom burden. During hospitalization, caregivers of intervention patients reported less increase in depression (p = 0.03). Caregivers of those in the intervention group reported improvement in coping compared to those in the control group (p = 0.02).

Palliative care during hospitalization for HCT was associated with lower fatigue and symptoms of anxiety and depression.

• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Unintended interventions or applicable interventions not described that would influence results
• Measurement validity/reliability questionable
• Other limitations/explanation: Interventions for symptom control were not described. Anxiety and depression scores were not at a clinically relevant level for HADS, so it is unclear that differences seen were meaningful.

Palliative care service can be beneficial to patients for management of symptoms during hospitalization for HCT.