Stem Cell Transplant and Palliative Care: Joining Forces to Improve Survivor Quality of Life

Incorporating palliative care (PC) is becoming the standard of care for patients with advanced solid tumors but stem cell transplant (SCT) patients infrequently receive early referral to PC. This may be due to a variety of reasons, including persistence of the belief that treatment aimed at cure contradicts the indication for palliative care. The purpose of this pilot project was to assess physical and psychological symptom burden in a baseline group of 30 patients undergoing autologous or allogeneic SCT. This was a prospective quality improvement project designed to obtain baseline data for use in developing a PC intervention of SCT patients. A simple modified 16-question Edmonton Symptom Assessment Survey (ESAS) was self-administered using an iPAD by 15 autologous and 15 allogeneic SCT patients just prior to admission (Time 1), and at time points T+10 (Time 2), and T+30 (Time 3). Tiredness was the most severe of all symptoms at all time points. Patients undergoing allogeneic SCT compared to autologous SCT reported higher levels of all symptoms at all time points. The differences between allogeneic vs autologous SCT approached significance for depression (p=.079) and anxiety (p=.063) at T1, tiredness (p=.064) at T2, and depression (p=.072) and tiredness (p=.056) at T3. The influences of type of SCT, age, gender, marital status on overall wellbeing, tiredness, pain, anxiety and depression were examined through linear regressions. The model for tiredness at T3 was the only significant model (adj.R2 = .376, p=.013), with gender and type of transplant making significant contributions. Palliative care integration offers the opportunity to add an additional layer of support to meet short term needs of SCT patients as well as symptoms arising in post-transplant survivorship. If PC resources are limited, this baseline assessment suggests allogeneic SCT patients are at higher risk for physical and psychological symptoms than autologous SCT patients.