Early Integrated Palliative Care is Beneficial for Patients with Advanced Blood Cancer

A study published in JAMA Oncology showed that early integration of palliative care for patients with advanced blood cancer was able to substantially improve patients’ quality of life (QoL), mood, and end-of-life care.

“A lot of work has been done on integration of palliative care for patients with solid tumors, but there has been less attention paid to the integration of palliative care for patients with blood cancers,” said co-author Areej El-Jawahri, MD, of the Massachusetts General Hospital Cancer Center, in a press release.

This multi-center trial enrolled 160 adult patients with advanced acute myeloid leukemia (AML) receiving intensive chemotherapy. Participants were randomized to either integrated palliative and oncology care (IPC; n=86) or standard care (n=74). QoL and depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms were measured via patient-reported surveys, which were completed at baseline and on weeks 2, 4, 12, and 24. Primary endpoint was QoL at week 2. Researchers also assessed patient-reported discussion of EOL care preferences and receipt of chemotherapy in the last 30 days of life.

Patients in the IPC were assigned palliative care specialists to discuss treatment goals, symptoms, and therapy decisions. Those who were assigned to receive usual care received support from their oncology team and were permitted to receive palliative care upon request. Six patients in the standard care cohort received early palliative care.

Overall, IPC participants reported better QoL scores and lower levels of depression, anxiety, and PTSD symptoms at week 2 compared with those who receiving only standard care. These benefits continued through week 24 for QoL (β, 2.35; 95% confidence interval [CI], 0.02 to 4.68; P=0.048), depression (β, −0.42; 95% CI, −0.82 to −0.02; P=0.04), anxiety (β, −0.38; 95% CI, −0.75 to −0.01; P=0.04), and PTSD symptoms (β, −1.43; 95% CI, −2.34 to −0.54; P=0.002). Of patients who died, those who received IPC were more likely to report discussing EOL preferences (75% vs 40%; P=0.01) and less likely to receive chemotherapy near EOL (34.9% vs. 65.9%; P=0.01).

“In this randomized clinical trial of patients with AML, IPC led to substantial improvements in QOL, psychological distress, and EOL care. Palliative care should be considered a new standard of care for patients with AML,” the researchers concluded.

Thanks @DukeHealth for highlighting our trial of #palliative care integration in leukemia! https://t.co/3F6Plixnbl @DukeHMCT @DukeCancer @dukemedicine #leusm #hapc #pallonc

— Thomas LeBlanc, MD, MA, MHS, FAAHPM (@tomleblancMD) December 17, 2020

Effectiveness of Integrated Palliative+ Oncology Care for Patients w/ Acute Myeloid Leukemia
– Dr. @Areejmd et al

4 centers, n=160
Integrated pall care (≥2/wk when inpatient) vs usual care
Primary endpt: QOL at 2 weeks (FACT-leukemia)#leusm #pallonchttps://t.co/LUAKqwN2Uf pic.twitter.com/Yf6Tx7uHMk

— Arjun Gupta (@guptaarjun90) December 17, 2020