Palliative care during and following allogeneic hematopoietic stem cell transplantation

Abstract

Palliative care interventions delivered by an interdisciplinary team that includes transplant clinicians and palliative care across the HSCT trajectory can alleviate physical and psychological morbidity, thereby improving the patient and family experience of HSCT.

What is known about palliative care in adult patients with allogeneic stem cell transplantation (allo-SCT)?

“…The impact of allo-SCT on symptoms and quality of life has been the topic of numerous reviews [ 19 , 52 – 64 ] and more recent primary studies (see Table 1 ). The most prevalent physical symptoms in the first 3 months after allo-SCT are fatigue, sleep disturbances, nausea, lack of appetite, and indigestion (obstipation or diarrhea) [ 27 , 32 , 56 ].…”

“…The early integration of specialist palliative care expertise in the transplant procedure aims at improving the experience of patients and caregivers throughout the individual trajectory, irrespective of whether that involves cure, chronic comorbidity, or death. This is achieved by improving symptom control, preventing and palliating psychosocial distress, enhancing patients’ and caregivers’ coping, and—if death nears—by caring through the last phase of life and by supporting caregivers’ bereavement [ 19 – 21 , 87 , 88 ]. This has been an emerging issue over the last years.…”

“…Several models of integration of specialist palliative care in (allo)-SCT have been proposed, ranging from a selective palliative care consult ordered by the transplant team to the upfront integration of palliative care specialists in routine transplant care [ 19 , 87 ]. However, such models of integration are implemented only in few institutions worldwide and thorough analyses of real-world clinical experiences are missing so far [ 19 , 87 ].…”

“…Further studies with a non-controlled prospective design supported the effectivity of other consultative models on palliative outcomes such as goals-of-care discussions, hospice referral, and keeping up hopes after talking to palliative care professionals [ 47 , 92 ]. There is a need for research also on other models of integration such as co-rounding, embedded models with routine inclusion of palliative care, or models for allo-SCT survivors [ 19 ].…”

“…These facts from clinical practice are reflected in the current state of research in this area. There are few prospective studies that investigated the effect of early-integrated palliative care into the therapeutic algorithms in hematology [ 17 , 18 ], in particular in allo-SCT [ 19 ], although recent results from randomized controlled trials indicate growing interest and research activity in that field [ 20 – 22 ].…”