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Palliative care for patients undergoing stem cell transplant: intervention components and supportive care measures

Bone Marrow Transplantation volume 56, pages 1971–1977 (2021)Cite this article

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Abstract

An inpatient palliative care intervention during HCT led to improvement in patient QOL and mood. We sought to describe components of the intervention, investigate differences in supportive care practices by treatment arm, and explore whether these differences mediated the impact of the intervention on patient QOL and mood. We conducted a secondary analysis of a randomized trial investigating inpatient palliative care integrated with transplant care versus standard transplant care for HCT recipients. Palliative care clinicians completed weekly surveys to describe topics addressed during visits. We extracted use of supportive care medications from the medical record. Participants completed QOL and mood assessments at baseline and two weeks post-HCT. Causal mediation assessed whether differences in supportive care practices mediated the impact of the intervention on patient-reported outcomes. A total of 160 HCT recipients participated. Palliative care visits most frequently focused on managing symptoms and coping with HCT. Patients randomized to the intervention were more likely to use Patient-Controlled Analgesia (PCA) (32.1% vs. 15.2%, p = 0.02) and atypical antipsychotics (35.8% vs. 17.7%, p = 0.01). Neither PCA nor atypical antipsychotics mediated the effect of the intervention on patient-reported outcomes. Future work to explore mechanisms by which the palliative care intervention improves QOL and mood is needed.

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Fig. 1: Content of palliative care visits.
Fig. 2: Symptoms addressed in palliative care visits.
Fig. 3: Palliative care symptom management.
Fig. 4: Proportion of patients receiving supportive care medications.

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Acknowledgements

We thank the patients for their participation in this study.

Funding

This work was supported by the National Palliative Care Research Center (El-Jawahri). Dr. El-Jawahri is a Scholar in Clinical Research of the Leukemia and Lymphoma Society. This was also supported by T32 CA092203 (PI: Schrag).

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Author notes

  1. These authors contributed equally: JA Greer, A El-Jawahri

Authors and Affiliations

  1. Massachusetts General Hospital, Boston, MA, USA

    Ashley M. Nelson, P. Connor Johnson, Alison R. Kavanaugh, Vicki A. Jackson, Annemarie D. Jagielo, Alyssa L. Fenech, Matthew J. Reynolds, Carlisle Topping, Alisha M. Yi, Nora Horick, Jennifer S. Temel, Joseph A. Greer & Areej El-Jawahri

  2. Harvard Medical School, Boston, MA, USA

    Ashley M. Nelson, P. Connor Johnson, Alison R. Kavanaugh, Vicki A. Jackson, Jennifer S. Temel, Joseph A. Greer & Areej El-Jawahri

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  1. Ashley M. Nelson
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Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data. All were involved in drafting the article or revising it critically for important intellectual content. All provided final approval of the manuscript and agree to accountable for all aspects of the work.

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Correspondence to Ashley M. Nelson.

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Conflict of interest

JAG receives royalties from Springer Humana Press, has research funding from Gaido Health/BCG Digital Ventures, and is a paid consultant from Concerto HealthAI and Blue Note Therapeutics. Other authors have no disclosures.

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Nelson, A.M., Johnson, P.C., Kavanaugh, A.R. et al. Palliative care for patients undergoing stem cell transplant: intervention components and supportive care measures. Bone Marrow Transplant 56, 1971–1977 (2021). https://doi.org/10.1038/s41409-021-01281-2

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