Characteristics and impact of post-transplant interdisciplinary palliative care consultation in older allogeneic hematopoietic cell transplant recipients Journal Article
| Authors: | Lin, R. J.; Cohen, A. G.; Stabler, S. M.; Devlin, S. M.; Elko, T. A.; Maloy, M. A.; Korc-Grodzicki, B.; Alexander, K.; Kramer, D.; Sanchez-Escamilla, M.; Castillo Flores, N.; Barker, J. N.; Cho, C.; Dahi, P. B.; Gyurkocza, B.; Papadopoulos, E. B.; Perales, M. A.; Politikos, I.; Ponce, D. M.; Sauter, C. S.; Scordo, M.; Shaffer, B. C.; Shah, G. L.; Tamari, R.; Young, J. W.; Jakubowski, A. A.; Giralt, S. A.; Nelson, J. E. |
| Article Title: | Characteristics and impact of post-transplant interdisciplinary palliative care consultation in older allogeneic hematopoietic cell transplant recipients |
| Abstract: | Context and Objectives: The myriad of benefits of early palliative care (PC) integration in oncology are well established, and emerging evidence suggests that PC improves symptom burden, mood, and quality of life for hematopoietic cell transplant (HCT) recipients. Specific impact of PC consultation on outcomes of older allogeneic HCT (allo-HCT) recipients, a historically high-risk population vulnerable to transplant-related complications and mortality, has not been explored. Design and Methods: In this single institution, retrospective analysis of 527 first allo-HCT recipients aged ≥60 years, we characterized 75 patients who had received post-HCT PC consultation and its association with geriatric vulnerabilities identified by pre-HCT geriatric assessment. We also examined end-of-life care outcomes among patients who died within one-year of allo-hematopoietic cell transplantation. Results: In multivariate analysis, higher disease risk, female gender, and, importantly, pre-HCT functional limitation (hazard ratio 2.35, 95% confidence interval, 1.35-4.09, p = 0.003) were associated with post-HCT PC utilization. Within one-year of hematopoietic cell transplantation, 127 patients died; among those, recipients of early PC consultation had significantly higher rates of hospice enrollment (25% vs. 9%, p = 0.019) and lower rates of hospital death (71% vs. 90%, p = 0.013), intensive care unit admission (44% vs. 75%, p = 0.001), and high-intensity medical care in last 30 days of life (46% vs. 77%, p = 0.001). Conclusions: Our results highlight important pre-HCT risk factors associated with increased PC needs posthematopoietic cell transplantation and benefits of PC involvement for older allo-HCT recipients at the end of life. Prospective studies should examine the optimal timing of PC consultation and its multidimensional benefits for older allo-HCT patients. Copyright © 2020 Mary Ann Liebert, Inc. |
| Keywords: | end-of-life care; geriatric assessment; hematopoietic cell transplantation; palliative care consultation |
| Journal Title: | Journal of Palliative Medicine |
| Volume: | 23 |
| Issue: | 12 |
| ISSN: | 1096-6218 |
| Publisher: | Mary Ann Liebert, Inc |
| Date Published: | 2020-12-01 |
| Start Page: | 1653 |
| End Page: | 1657 |
| Language: | English |
| DOI: | 10.1089/jpm.2019.0611 |
| PUBMED: | 32216649 |
| PROVIDER: | scopus |
| PMCID: | PMC7698973 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 4 January 2021 -- Source: Scopus |
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