End-of-Life Aspects in a Hematopoietic Stem Cell Transplantation Unit: The Integration of Palliative Care Group in the Transplant Process

Abstract

Topic Significance & Study Purpose/Background/Rationale Patients submitted to Hematopoietic Stem Cell Transplantation (HSCT) are affected by a burden of symptoms arising from conditioning treatment, clinical complications such infections, bleeding disorders, leading to physical and psychological suffering. The understanding of how hematological patients are managed in the end-of-life may provide improvement in the quality of care since it seems hematological patients have less access to palliative care (PC) when compared to solid tumors. The aim of this study was evaluate the end-of-life scenario of our patients that died after HSCT followed or not by PC team and try to improve the care practice of this patients Methods, Intervention, & Analysis We retrospectively analyzed patients submitted to HSCT who died between January, 2010 and July, 2018 in a single private hospital in Sao Paulo, Brazil. It was recorded cause of death: if TRM (Transplant related Mortality) or relapse/ disease progression (DP) related; the local of death ICU (intensive care unit) or regular room and PC team intervention. For statistical analysis was used Chi-square and likelihood ratio test. Findings & Interpretation A total of 460 patients received HSCT in this period. 345 (75%) adults and 115 (25%) pediatrics. Among them 125 (27,1%) died 101 (80%) adults and 24 (20%) children. In the pediatric population 15 (62.5%) died due TRM and all died in the ICU, PC team followed just one (7%) patient. Nine (37.5%) died due DP, and just one (4%) patient was followed by PC team, and died in regular room free of invasive therapy. In the adult population 55 (54,5%) died due TRM, the PC team followed 10 (18%), of them and; 8 (14.5%) died in ICU. Forty-six (45.5%) of patients died by DP and, 26 patients (56.5%) were followed by PC team, and 16 (35%) died in regular room. Twenty patients were not followed by CP team and 17 (37%) out 20 died in the ICU. In the adult population patients who were followed by PC team have less chance of being transferred to ICU (p Discussion & Implications Our mortality rate is similar to literature, but few patients were followed by PC team. A new practice was established in January 2018 and PC team starts evaluating all adult patients undergoing HSCT. The first visits was in the pre transplant evaluation and then followed by weekly visits during admission period interfering in symptoms management, with this we hope to increase the quality of the assistance offered in the final stage of life. In respect to pediatric patients we are in the process of evaluating our gaps for service implementation. When the PC team is introduced we observed an improved management of patients, family and health team with a decrease of transfers for ICU, giving better quality at the end of life.