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Palliative Care for the Hematopoietic Cell Transplant and Cellular Therapy Clinician

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Supportive Care Strategies

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Abstract

Hematopoietic cell transplant and cellular therapy is a multidisciplinary practice that includes palliative care services and specialists. Patients with hematologic malignancies and those who require transplant have many palliative care needs including addressing the acute and long-term experiences of significant pain, non-pain, and psychological symptom burdens of their disease and treatments, management of acute and chronic graft-versus-host disease, and addressing advance care planning and quality end-of-life care treatment. Despite these palliative care needs, involvement of specialty palliative care in hematopoietic cell transplant is grossly underutilized even with randomized control studies demonstrating symptom burden improvements, survival benefits, and ability to provide palliative care services by a variety of methods by timing, setting, and mode of delivery. In addition to improving patient outcomes and quality of life, similar effects have been demonstrated for patient caregivers by palliative care interventions. Barriers to palliative care in patients with hematologic malignancies and hematopoietic cell transplant include poor understanding of the full spectrum of palliative care services and need for palliative transfusion support at advanced stages of cancer. Further research is needed to assess the palliative care needs of patients with hematologic malignancies including the spectrum of cancer types, disease trajectories, and patient populations. To inform oncologists’ clinical practice in this regard, this chapter will review the evidence of unmet palliative care needs in hematology, describe and define the scope of palliative care, discuss the challenges to its integration in hematology, and provide a model for care moving forward.

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References

  • Azoulay E, Mokart D, Pene F et al (2013) Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium—a groupe de recherche respiratoire en reanimation onco-hematologique study. J Clin Oncol 31(22):2810–2818

    PubMed  Google Scholar 

  • Azoulay E, Lemiale V, Mokart D et al (2014) Acute respiratory distress syndrome in patients with malignancies. Intensive Care Med 40(8):1106–1114

    PubMed  Google Scholar 

  • Back AL, Park ER, Greer JA et al (2014) Clinician roles in early integrated palliative care for patients with advanced cancer: a qualitative study. J Palliat Med 17(11):1244–1248

    PubMed  PubMed Central  Google Scholar 

  • Bakitas M, Lyons KD, Hegel MT et al (2009) Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA 302(7):741–749

    CAS  PubMed  PubMed Central  Google Scholar 

  • Bakitas MA, Tosteson TD, Li Z et al (2015) Early versus delayed initiation of concurrent palliative oncology care: patient outcomes in the ENABLE III randomized controlled trial. J Clin Oncol 33(13):1438–1445

    PubMed  PubMed Central  Google Scholar 

  • Bevans M, El-Jawahri A, Tierney DK et al (2017) National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: consensus recommendations for patient-centered outcomes. Biol Blood Marrow Transplant 23(4):538–551

    PubMed  Google Scholar 

  • CAPC (2011) Public opinion research on palliative care. https://media.capc.org/filer_public/18/ab/18ab708c-f835-4380-921d-fbf729702e36/2011-public-opinion-research-on-palliative-care.pdf. Accessed Oct 2016

  • Dionne-Odom JN, Azuero A, Lyons KD et al (2015) Benefits of early versus delayed palliative care to informal family caregivers of patients with advanced cancer: outcomes from the ENABLE III randomized controlled trial. J Clin Oncol 33(13):1446–1452

    PubMed  PubMed Central  Google Scholar 

  • El-Jawahri A (2016) A collaborative palliative and oncology care model for patients with acute myeloid leukemia. https://clinicaltrials.gov/ct2/show/study/NCT02975869. Accessed 14 Dec 2016

  • El-Jawahri A, Traeger L, Park ER et al (2014) Associations among prognostic understanding, quality of life, and mood in patients with advanced cancer. Cancer 120(2):278–285

    PubMed  Google Scholar 

  • El-Jawahri AR, Traeger LN, Kuzmuk K et al (2015a) Quality of life and mood of patients and family caregivers during hospitalization for hematopoietic stem cell transplantation. Cancer 121(6):951–959

    PubMed  Google Scholar 

  • El-Jawahri AR, Abel GA, Steensma DP et al (2015b) Health care utilization and end-of-life care for older patients with acute myeloid leukemia. Cancer 121(16):2840–2848

    PubMed  Google Scholar 

  • El-Jawahri A, Traeger L, Kuzmuk K et al (2015c) Prognostic understanding, quality of life and mood in patients undergoing hematopoietic stem cell transplantation. Bone Marrow Transplant 50(8):1119–1124

    CAS  PubMed  PubMed Central  Google Scholar 

  • El-Jawahri A, LeBlanc T, VanDusen H et al (2016a) Effect of inpatient palliative care on quality of life 2 weeks after hematopoietic stem cell transplantation. JAMA Intern Med 316(20):2094–2013

    Google Scholar 

  • El-Jawahri A, Jackson VA, Greer JA, et al (2016b) Effect of early integrated palliative care on family caregivers outcomes for patients with gastrointestinal and lung cancer. Paper presented at palliative care in oncology symposium; San Francisco, CA

    Google Scholar 

  • Epstein AS, Goldberg GR, Meier DE (2012) Palliative care and hematologic oncology: the promise of collaboration. Blood Rev 26(6):233–239

    PubMed  Google Scholar 

  • Fadul NA, El Osta B, Dalal S, Poulter VA, Bruera E (2008) Comparison of symptom burden among patients referred to palliative care with hematologic malignancies versus those with solid tumors. J Palliat Med 11(3):422–427

    PubMed  Google Scholar 

  • Ferrell BR, Temel JS, Temin S et al (2017) Integration of palliative care into standard oncology care: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 13(2):119–121

    Google Scholar 

  • Fiuza-Luces C, Simpson RJ, Ramirez M, Lucia A, Berger NA (2016) Physical function and quality of life in patients with chronic GvHD: a summary of preclinical and clinical studies and a call for exercise intervention trials in patients. Bone Marrow Transplant 51(1):13–26

    CAS  PubMed  Google Scholar 

  • Fraser CJ, Bhatia S, Ness K et al (2006) Impact of chronic graft-versus-host disease on the health status of hematopoietic cell transplantation survivors: a report from the Bone Marrow Transplant Survivor Study. Blood 108(8):2867–2873

    CAS  PubMed  PubMed Central  Google Scholar 

  • Goetzmann L, Ruegg L, Stamm M et al (2008) Psychosocial profiles after transplantation: a 24-month follow-up of heart, lung, liver, kidney and allogeneic bone-marrow patients. Transplantation 86(5):662–668

    PubMed  Google Scholar 

  • Greer JA, El-Jawahri A, Pirl WF, et al (2016) Randomized trial of early integrated palliative and oncology care. In: Palliative care in oncology symposium, San Francisco, CA

    Google Scholar 

  • Grudzen CR, Richardson LD, Johnson PN et al (2016) Emergency department-initiated palliative care in advanced cancer: a randomized clinical trial. JAMA Oncol 2:591

    PubMed  Google Scholar 

  • Heinonen H, Volin L, Zevon MA, Uutela A, Barrick C, Ruutu T (2005) Stress among allogeneic bone marrow transplantation patients. Patient Educ Couns 56(1):62–71

    PubMed  Google Scholar 

  • Howell DA, Shellens R, Roman E, Garry AC, Patmore R, Howard MR (2011) Haematological malignancy: are patients appropriately referred for specialist palliative and hospice care? A systematic review and meta-analysis of published data. Palliat Med 25(6):630–641

    PubMed  Google Scholar 

  • Howell DA, Wang HI, Smith AG, Howard MR, Patmore RD, Roman E (2013) Place of death in haematological malignancy: variations by disease sub-type and time from diagnosis to death. BMC Palliat Care 12(1):42

    PubMed  PubMed Central  Google Scholar 

  • Howell DA, Wang HI, Roman E et al (2017) Preferred and actual place of death in haematological malignancy. BMJ Support Palliat Care 7(2):150–157

    CAS  PubMed  Google Scholar 

  • Hui D, Didwaniya N, Vidal M et al (2014) Quality of end-of-life care in patients with hematologic malignancies: a retrospective cohort study. Cancer 120(10):1572–1578

    PubMed  Google Scholar 

  • Hui D, Park M, Liu D, Reddy A, Dalal S, Bruera E (2015) Attitudes and beliefs toward supportive and palliative care referral among hematologic and solid tumor oncology specialists. Oncologist 20(11):1326–1332

    PubMed  PubMed Central  Google Scholar 

  • Irwin KE, Greer JA, Khatib J, Temel JS, Pirl WF (2013) Early palliative care and metastatic non-small cell lung cancer: potential mechanisms of prolonged survival. Chron Respir Dis 10(1):35–47

    PubMed  Google Scholar 

  • Khera N, Chang YH, Hashmi S et al (2014) Financial burden in recipients of allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 20(9):1375–1381

    PubMed  Google Scholar 

  • LeBlanc TW (2014) Palliative care and hematologic malignancies: old dog, new tricks? J Oncol Pract 10(6):e404–e407

    PubMed  Google Scholar 

  • LeBlanc TW, Abernethy AP (2013) Quality of life in higher resolution: the next generation of comparative effectiveness research in malignant hematology. Haematologica 98(6):823–824

    PubMed  PubMed Central  Google Scholar 

  • LeBlanc TW, El-Jawahri A (2015) When and why should patients with hematologic malignancies see a palliative care specialist? Hematology 2015:471–478

    PubMed  Google Scholar 

  • LeBlanc TW, Smith JM, Currow DC (2015a) Symptom burden of haematological malignancies as death approaches in a community palliative care service: a retrospective cohort study of a consecutive case series. Lancet Haematol 2(8):e334–e338

    PubMed  Google Scholar 

  • LeBlanc TW, Abernethy AP, Casarett DJ (2015b) What is different about patients with hematologic malignancies? A retrospective cohort study of cancer patients referred to a hospice research network. J Pain Symptom Manag 49(3):505–512

    Google Scholar 

  • LeBlanc TW, O’Donnell JD, Crowley-Matoka M et al (2015c) Perceptions of palliative care among hematologic malignancy specialists: a mixed-methods study. J Oncol Pract 11(2):e230–e238

    PubMed  PubMed Central  Google Scholar 

  • LeBlanc TW, Fish LJ, Bloom CT et al (2017) Patient experiences of acute myeloid leukemia (AML): a qualitative study about diagnosis, illness understanding, and treatment decision-making. Psycho-Oncology 26(12):2063–2068

    PubMed  Google Scholar 

  • Manitta V, Zordan R, Cole-Sinclair M, Nandurkar H, Philip J (2011) The symptom burden of patients with hematological malignancy: a cross-sectional observational study. J Pain Symptom Manag 42(3):432–442

    Google Scholar 

  • Mannis GN, McNey LM, Gupta NK, Gross DM (2016) The transfusion tether: bridging the gap between end-stage hematologic malignancies and optimal end-of-life care. Am J Hematol 91(4):364–365

    PubMed  Google Scholar 

  • McDonald J, Swami N, Hannon B et al (2017) Impact of early palliative care on caregivers of patients with advanced cancer: cluster randomised trial. Ann Oncol 28(1):163–168

    CAS  PubMed  Google Scholar 

  • McGrath P (2001) Caregivers’ insights on the dying trajectory in hematology oncology. Cancer Nurs 24(5):413–421

    CAS  PubMed  Google Scholar 

  • McGrath P (2002) Qualitative findings on the experience of end-of-life care for hematological malignancies. Am J Hosp Palliat Care 19(2):103–111

    PubMed  Google Scholar 

  • Mosher CE, Redd WH, Rini CM, Burkhalter JE, DuHamel KN (2009) Physical, psychological, and social sequelae following hematopoietic stem cell transplantation: a review of the literature. Psycho-Oncology 18(2):113–127

    PubMed  PubMed Central  Google Scholar 

  • Nipp RD, El-Jawahri A, Fishbein JN et al (2016a) The relationship between coping strategies, quality of life, and mood in patients with incurable cancer. Cancer 122(13):2110–2116

    PubMed  Google Scholar 

  • Nipp RD, Greer JA, El-Jawahri A et al (2016b) Age and gender moderate the impact of early palliative care in metastatic non-small cell lung cancer. Oncologist 21(1):119–126

    PubMed  Google Scholar 

  • Nissim R, Zimmermann C, Minden M et al (2013) Abducted by the illness: a qualitative study of traumatic stress in individuals with acute leukemia. Leuk Res 37(5):496–502

    PubMed  PubMed Central  Google Scholar 

  • Odejide OO, Salas Coronado DY, Watts CD, Wright AA, Abel GA (2014) End-of-life care for blood cancers: a series of focus groups with hematologic oncologists. J Oncol Pract 10(6):e396–e403

    PubMed  PubMed Central  Google Scholar 

  • Odejide OO, Cronin AM, Condron N, Earle CC, Wolfe J, Abel GA (2016a) Timeliness of end-of-life discussions for blood cancers: a National Survey of Hematologic Oncologists. JAMA Intern Med 176(2):263–265

    PubMed  Google Scholar 

  • Odejide OO, Cronin AM, Earle CC, LaCasce AS, Abel GA (2016b) Hospice use among patients with lymphoma: impact of disease aggressiveness and curability. J Natl Cancer Inst 108(1):djv280. https://doi.org/10.1093/jnci/djv280

  • Odejide OO, Cronin AM, Condron NB et al (2016c) Barriers to quality end-of-life care for patients with blood cancers. J Clin Oncol 34(26):3126–3132

    PubMed  Google Scholar 

  • Pene F, Percheron S, Lemiale V et al (2008) Temporal changes in management and outcome of septic shock in patients with malignancies in the intensive care unit. Crit Care Med 36(3):690–696

    PubMed  Google Scholar 

  • Quill TE, Abernethy AP (2013) Generalist plus specialist palliative care—creating a more sustainable model. N Engl J Med 368(13):1173–1175

    CAS  PubMed  Google Scholar 

  • Roeland E, Mitchell W, Elia G et al (2010a) Symptom control in stem cell transplantation: a multidisciplinary palliative care team approach. Part 1: Physical symptoms. J Support Oncol 8(3):100–116

    CAS  PubMed  Google Scholar 

  • Roeland E, Mitchell W, Elia G et al (2010b) Symptom control in stem cell transplantation: a multidisciplinary palliative care team approach. Part 2: psychosocial concerns. J Support Oncol 8(4):179–183

    PubMed  Google Scholar 

  • Smith TJ, Temin S, Alesi ER et al (2012) American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol 30(8):880–887

    PubMed  Google Scholar 

  • Socie G, Salooja N, Cohen A et al (2003) Nonmalignant late effects after allogeneic stem cell transplantation. Blood 101(9):3373–3385

    CAS  PubMed  Google Scholar 

  • Syrjala KL, Langer SL, Abrams JR et al (2004) Recovery and long-term function after hematopoietic cell transplantation for leukemia or lymphoma. JAMA 291(19):2335–2343

    CAS  PubMed  Google Scholar 

  • Temel JS, Greer JA, Muzikansky A et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363(8):733–742

    CAS  PubMed  Google Scholar 

  • Temel JS, Greer JA, El-Jawahri A et al (2017) Effects of early integrated palliative care in patients with lung and GI cancer: a randomized clinical trial. J Clin Oncology 35(8):834–841

    Google Scholar 

  • Wang WS, Ma JD, Nelson SH et al (2016a) Advance care planning and palliative care consultation for stem cell transplant patients. In: Palliative care in oncology symposium, San Francisco, CA

    Google Scholar 

  • Wang WS, Ma JD, Nelson SH et al (2016b) Blood transfusions at end of life for stem cell transplant patients. 115–15.

    Google Scholar 

  • Yoong J, Park ER, Greer JA et al (2013) Early palliative care in advanced lung cancer: a qualitative study. JAMA Intern Med 173(4):283–290

    PubMed  Google Scholar 

  • Zimmermann C, Swami N, Krzyzanowska M et al (2014) Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet (London, England) 383(9930):1721–1730

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Palliative Care, UT Southwestern, Dallas, TX, USA

    Winnie Wang

  2. Department of Hematology Oncology, Massachusetts General Hospital, Boston, MA, USA

    Eric Roeland

  3. Department of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA

    Thomas LeBlanc

  4. Department of Hematology, Oncology, Bone Marrow Transplant, Massachusetts General Hospital, Boston, MA, USA

    Areej El-Jawahri

Authors
  1. Winnie Wang
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  2. Eric Roeland
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  3. Thomas LeBlanc
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  4. Areej El-Jawahri
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Corresponding author

Correspondence to Eric Roeland .

Editor information

Editors and Affiliations

  1. Hematology, Oncology, and Bone Marrow Transplant, Ochsner Health, New Orleans, LA, USA

    Laura Finn

  2. Palliative Medicine and Comprehensive Care, Inova Health System, Falls Church, VA, USA

    Alva R. Roche Green

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Wang, W., Roeland, E., LeBlanc, T., El-Jawahri, A. (2020). Palliative Care for the Hematopoietic Cell Transplant and Cellular Therapy Clinician. In: Finn, L., Roche Green, A.R. (eds) Supportive Care Strategies. Advances and Controversies in Hematopoietic Transplantation and Cell Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-59014-1_2

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  • DOI: https://doi.org/10.1007/978-3-319-59014-1_2

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