Palliative Care for the Hematopoietic Cell Transplant and Cellular Therapy Clinician

Abstract

Hematopoietic cell transplant and cellular therapy is a multidisciplinary practice that includes palliative care services and specialists. Patients with hematologic malignancies and those who require transplant have many palliative care needs including addressing the acute and long-term experiences of significant pain, non-pain, and psychological symptom burdens of their disease and treatments, management of acute and chronic graft-versus-host disease, and addressing advance care planning and quality end-of-life care treatment. Despite these palliative care needs, involvement of specialty palliative care in hematopoietic cell transplant is grossly underutilized even with randomized control studies demonstrating symptom burden improvements, survival benefits, and ability to provide palliative care services by a variety of methods by timing, setting, and mode of delivery. In addition to improving patient outcomes and quality of life, similar effects have been demonstrated for patient caregivers by palliative care interventions. Barriers to palliative care in patients with hematologic malignancies and hematopoietic cell transplant include poor understanding of the full spectrum of palliative care services and need for palliative transfusion support at advanced stages of cancer. Further research is needed to assess the palliative care needs of patients with hematologic malignancies including the spectrum of cancer types, disease trajectories, and patient populations. To inform oncologists’ clinical practice in this regard, this chapter will review the evidence of unmet palliative care needs in hematology, describe and define the scope of palliative care, discuss the challenges to its integration in hematology, and provide a model for care moving forward.