Effects of Palliative Care on Quality of Life and Psychological Distress of Patients Undergoing Hematopoietic Stem Cell Transplantation (HSCT) and Their Caregivers

Background Patients undergoing HSCT and their caregivers endure substantial psychological distress during the transplant hospitalization. Prior single-center studies established the feasibility and promising efficacy of integrating palliative care during the HSCT hospitalization. However, data regarding the efficacy of this care model across diverse care settings are lacking. Methods We conducted a multi-site randomized trial among 360 adults with hematologic malignancies undergoing autologous or allogeneic HSCT and their caregivers at three academic institutions. Patients without an interested caregiver were still eligible to participate. Patients and their caregivers were randomly assigned to an inpatient palliative care intervention (n=180) versus usual care (n=180), stratified by study site and HSCT type. Intervention participants met with a palliative care clinician at least twice weekly during the HSCT hospitalization to address their symptoms. Patients assigned to usual care received all supportive care measures provided by the HSCT team. We assessed quality of life (QOL; (Patient: Functional Assessment of Cancer Therapy – Bone Marrow Transplant; Caregiver: Caregiver Oncology QOL questionnaire), depression and anxiety symptoms (Hospital Anxiety and Depression Scale), and patients’ post-traumatic stress (PTSD) symptoms (PTSD Checklist) at baseline, week-2, 3, and 6 months post-HSCT. The primary endpoint was patients’ QOL at week-2 during the HSCT hospitalization when patients typically experience their QOL nadir. We used linear regression, adjusting for baseline scores, to evaluate the effect of the intervention on participant-reported outcomes at week-2. We used linear mixed effect models to assess the effect of the intervention on study outcomes longitudinally across all time points. Results We enrolled 69.5% (360/518) of eligible patients and 186 caregivers between October 2018 and July 2022. Compared to those receiving usual care, patients receiving the intervention reported better QOL (B=4.6, P<0.001), and lower depression (B=-0.9, P=0.042) and PTSD symptoms (B=-2.2, P=0.014) at week-2. Patient-reported anxiety did not differ significantly between the two groups at week-2. Intervention caregivers reported lower anxiety symptoms (B=-0.97, P=0.042) at week-2, but no differences in QOL or depression symptoms. In the longitudinal analyses, patients receiving the intervention reported lower PTSD symptoms up to six months post-HSCT (B=-0.81, P=0.020). All other participant-reported outcomes did not differ longitudinally between the two groups. Conclusions Palliative care led to substantial improvements in patients’ QOL, depression and PTSD symptoms, as well as caregiver anxiety during HSCT hospitalization with sustained effects on patients’ PTSD symptoms up to six months post-HSCT.