Palliative Care in HSCT Correlates With Longer Survival in Hematologic Cancers

Article

A retrospective analysis of more than 17,000 patients with hematologic malignancies identified a difference in median survival between patients who received palliative care in addition to hematopoietic stem cell transplantation and those who didn’t.

Palliative Care in HSCT Correlates With Longer Survival in Hematologic Cancers | Image Credit: © Kateryna_Kon - stock.adobe.com.

"Our data suggests that integrating palliative care could possibly improve survival in these patients likely due to better compliance with immunosuppressants and being able to navigate the health care system better and, more importantly, have a stronger support system," according to Naveen Premnath, MD, a hematology and oncology fellow at University of Texas Southwestern Medical Center in Dallas, Texas.

Receipt of palliative care resulted in longer survival among patients with hematologic malignancies who had undergone hematopoietic stem cell transplantation (HSCT), according to a retrospective analysis from the University of Texas Southwestern Medical Center that was published in the Journal of Clinical Oncology.

Investigators assessed outcomes across 17,464 eligible patients using the National Cancer Database (NCDB) and found that those who received palliative care had a median survival of 43.5 months compared with 31.6 months among those who didn’t (P = .0003). Moreover, palliative care correlated with improved survival according to a multivariable analysis which adjusted for age, sex, income, ethnicity, insurance status, and Charlson-Deyo Comorbidity Index (hazard ratio [HR], 0.85; CI, 0.77-0.93; P = .0002).

These data were presented at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting.

“This is the largest study that evaluated the use of palliative care among bone marrow transplant patients,” lead study author Naveen Premnath, MD, stated in a written comment to CancerNetwork®.

“Patients who received palliative care prior to bone marrow transplant had a survival advantage even when adjusted for other factors that influence survival like age, sex, comorbidities, insurance status, income status, and ethnicity. This advantage was present despite the group of patients who received palliative care being from the lower income group.”

Premnath is a hematology and oncology fellow at the University of Texas Southwestern Medical Center in Dallas, Texas.

The analysis included patients who underwent HSCT from 2004 to 2017. Investigators usedchi-squaretests to compare categorical variables and Wilcoxon tests to compare continuous variables. Additionally, they conducted Kaplan Meier analysis and a Cox multivariable proportional hazards model using R software to assess survival in this patient population.

Premnath also described the types of palliative care strategies administered to patients who were included in the analysis.

“The database is able to identify palliative surgery, radiation, or systemic treatment,” Premnath stated. “We have reported systemic treatment in our study as these patients did not receive surgery or radiation, as they are not part of treatment for hematological malignancies. This systemic treatment can be symptom management or pain management. However, this granularity is not available.”

Most of the assessed population had not undergone palliative care (n = 16,828). Those who did (n = 636) had a median age of 58 years, which was slightly higher than their counterparts who had a median age of 57 years old (P <.001). Overall, 60.5% of those in the palliative care group and 58.8% of the control group were male (P = .40), and Hispanic patients made up 4.24% and 6.16% of each respective group (P = .06).

A minority of patients from both groups, respectively, were uninsured—2.9% vs 3.36%, (P = .69)—and classified as being from a low income household—16.5% vs 13.01% (P = .009). This low-income category included all patients with a median household income inside the lowest quartile of earners according to 2016 survey data.

Overall, 81.6% of patients in the palliative care group and 83.0% of those who never received palliative care had a Charlson-Deyo comorbidity index score of 0 (P = .38). A further 13.6% and 13.2%, respectively, had a score of 1 (P = .38), and 3.8% vs 2.7% had a score of 2 (P = .38).

“This is a retrospective analysis, and these findings are correlational. This study is, however, a step in the right direction to argue for prospective studies in patients [who received] bone marrow transplantation,” Premnath stated.

Premnath also indicated how he plans to expand upon the results of this nationwide analysis with additional research.

“Most solid organ transplant societies recommend integration of psychiatric and sociodemographic evaluation and support systems prior to transplant, and some institutes [recommend] palliative care,” he stated. “I am looking for a grant support to propose a prospective trial to incorporate palliative care in patients prior to bone marrow transplant. We hope to see if there would be survival advantage with the integration of early palliative care and or improvement in quality of life of patients receiving bone marrow transplant.”

Investigators noted that this analysis was exempt from review by an Institutional Review Board (IRB) because of the de-identified nature of the NCDB data.

“The process of bone marrow transplant is complex and difficult to navigate for most patients. Our data suggests that integrating palliative care could possibly improve survival in these patients likely due to better compliance with immunosuppressants and being able to navigate the health care system better and, more importantly, have a stronger support system,” Premnath concluded.

Reference

Premnath N, Khan A, Pandey M, et al. Palliative care in hematopoietic stem cell transplant recipients and impact on survival: a nationwide analysis. J Clin Oncol. 2023;41(suppl 16):12129. doi:10.1200/JCO.2023.41.16_suppl.12129

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