Effect of Inpatient Palliative Care on Quality of Life 2 Weeks After Hematopoietic Stem Cell Transplantation A Randomized Clinical Trial
Effect of Inpatient Palliative Care on Quality of Life 2 Weeks After Hematopoietic Stem Cell Transplantation A Randomized Clinical Trial
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DOI：
10.1001/jama.2016.16786
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发表时间：
2016-11-22
影响因子：
120.7
通讯作者：
Temel, Jennifer S.
中科院分区：
文献类型：
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作者：
El-Jawahri, Areej;LeBlanc, Thomas;Temel, Jennifer S.
在造血干细胞移植(HCT)住院期间，患者在移植前接受大剂量化疗，并经历显著的生理和心理症状和较差的生活质量(QOL)。目的评估住院姑息护理对HCT住院期间和移植后3个月患者和照顾者报告的结果的影响。设计、设置和参与者对160例接受自体/异基因HCT的成人血液系统恶性肿瘤患者和他们的照顾者(n=94)进行非盲法随机临床试验。这项研究于2014年8月至2016年1月在波士顿一家医院进行；随访于2016年5月完成。在HCT住院期间，分配到干预组(n=81)的姑息治疗临床医生每周至少看两次；姑息干预侧重于控制身体和心理症状。分配到标准移植护理的患者(n=79)可以由姑息护理临床医生根据要求进行观察。主要结果和测量：主要是患者的生活质量从基线到第2周的变化；其次：患者评估的情绪、疲劳和症状负担评分在基线、HCT后2周和3个月，以及照顾者评估的基线和HCT后2周的QOL和情绪。中位住院天数21天)和94名照顾者完成2周随访者分别为157人(98.1%)和(94.7%)，149人(93.1%)完成3个月随访期。与对照组相比，从基线到第二周，干预组患者的生活质量下降幅度较小。干预组患者抑郁增加较少，焦虑较少，疲劳无明显差异，症状负担增加较少。在3个月时，干预患者的生活质量较高，抑郁较少，但在焦虑、疲劳或症状负担方面没有显著差异。从基线到HCT后2周，干预组患者的照顾者与对照组的照顾者在生活质量或焦虑方面没有显著差异，但在抑郁方面有较小的增加(平均0.25vs1.80；平均差异1.55；95%CI，0.14-2.96；P=.03)。[图表]结论和相关性：在单一机构接受HCT治疗血液恶性肿瘤的成年人中，与标准移植护理相比，使用住院姑息治疗导致移植后2周的QOL下降较小。还需要进一步的研究来推广和评估较长期的结果和成本影响。
IMPORTANCE During hospitalization for hematopoietic stem cell transplantation (HCT), patients receive high-dose chemotherapy before transplantation and experience significant physical and psychological symptoms and poor quality of life (QOL).OBJECTIVE To assess the effect of inpatient palliative care on patient-and caregiver-reported outcomes during hospitalization for HCT and 3 months after transplantation.DESIGN, SETTING, AND PARTICIPANTS Nonblinded randomized clinical trial among 160 adults with hematologic malignancies undergoing autologous/allogeneic HCT and their caregivers (n = 94). The study was conducted from August 2014 to January 2016 in a Boston hospital; follow-up was completed in May 2016.INTERVENTIONS Patients assigned to the intervention (n= 81) were seen by palliative care clinicians at least twice a week during HCT hospitalization; the palliative intervention was focused on management of physical and psychological symptoms. Patients assigned to standard transplant care (n= 79) could be seen by palliative care clinicians on request.MAIN OUTCOMES AND MEASURES Primary: change in patient QOL from baseline to week 2; secondary: patient-assessed mood, fatigue, and symptom burden scores at baseline, 2 weeks, and 3 months after HCT and caregiver-assessed QOL and mood at baseline and 2 weeks after HCT.RESULTS Among 160 patients (mean age, 60[SD, 13.3] years; 91 women[56.9%]; median hospital stay, 21 days) and 94 caregivers, 157(98.1%) and 89(94.7%), respectively, completed 2-week follow-up, and 149 patients(93.1%) completed 3-month follow-up. Intervention patients reported a smaller decrease in QOL from baseline to week 2 vs controls. Intervention patients had less increase in depression, lower anxiety, no difference in fatigue, and less increase in symptom burden. At 3 months, intervention patients had higher QOL and less depression but no significant differences in anxiety, fatigue, or symptom burden. From baseline to week 2 after HCT, caregivers of intervention patients vs controls reported no significant differences in QOL or anxiety but had a smaller increase in depression (mean, 0.25 vs 1.80; mean difference, 1.55; 95% CI, 0.14-2.96; P =.03).[GRAPHICS]CONCLUSIONS AND RELEVANCE Among adults at a single institution undergoing HCT for hematologic malignancy, the use of inpatient palliative care compared with standard transplant care resulted in a smaller decrease in QOL 2 weeks after transplantation. Further research is needed for replication and to assess longer-term outcomes and cost implications.