Early palliative care interventions in patients with hematologic malignancies prior to hematopoietic cell transplantation.

Abstract

e21634 Background: Early palliative care (EPC) interventions have been endorsed by multiple medical societies, mostly for solid tumors but not for hematological malignancies. Patients undergoing hematopoietic stem cell transplantation (HSCT) suffer significant physical and emotional distress affecting negatively their quality of life (QOL). They also receive more aggressive end-of-life interventions than other cancer patients. Few studies have shown the impact of EPC in the pre-transplant phase on post transplant morbidity and mortality. Methods: 53 patients undergoing HSCT were evaluated on the supportive care clinic for symptom and needs assessment using the Edmonton symptom assessment scale (ESAS) to evaluate symptom burden prior to transplant. Consecutive palliative care visits were offered to patients. We also evaluated whether the supportive care clinic (SCC) visits made a difference on hospitalization rate and mortality comparing this group with 108 patient who did not undergo evaluation. Kaplan-Meier method and log-rank test were used in the survival analysis and Fisher’s exact test was used in the data analysis for categorical variables. Results: The most common symptoms reported by patients included: fatigue (4.4), sleep problems (3.7), pain (2.8), anxiety (2.8), well-being (2.7), and drowsiness (2.3). 26% (14) of the patients were followed in the SCC at 3 months. The most common symptoms at that time included fatigue (5.1), pain (4), drowsiness (3.6), sleep problems (3.1), well-being (2.9), and appetite (2.4). Overall mortality for the whole group was 24%. 28% for the palliative care group and 21% for the control group. Odds Ratio for mortality at 3 and 6 months were not significantly different between groups. Differences in hospital admissions were also not statistically significant. Conclusions: EPC in HSCT patients is feasible and may help with symptom detection and control. No effect on mortality or hospital admission rates was found on this study on patients referred for EPC interventions. Prospective studies are needed to clearly define the role of EPC in HSCT patients.