Pretransplantation Supportive and Palliative Care Consultation for High-Risk Hematopoietic Cell Transplantation Patients
Pretransplantation Supportive and Palliative Care Consultation for High-Risk Hematopoietic Cell Transplantation Patients
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DOI：
10.1016/j.bbmt.2016.03.006
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发表时间：
2016-07-01
影响因子：
4.3
通讯作者：
Lee, Stephanie J.
中科院分区：
文献类型：
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作者：
Loggers, Elizabeth T.;LeBlanc, Thomas W.;Lee, Stephanie J.
转移性实体瘤患者的早期姑息治疗（EPC）现在是标准治疗，但EPC在造血细胞移植（HCT）中的作用尚不清楚。我们通过试验参与、患者报告结局的变化以及姑息治疗提供者的随访来研究HCT前EPC的可接受性。HCT合并症指数>= 3、复发风险> 25%或计划进行HLA错配异基因或清髓性HCT的讲英语的成人（年龄>17岁）在HCT入院前接受EPC治疗，每月或更频繁地进行一次访视。32例受试者中有22例（69%）提供了知情同意书; 2例后来被排除（HCT取消，撤回知情同意书），参与率为63%。EPC的舒适度很高（82%非常舒适）。受试者报告稳定或改善的情绪和希望感，没有明显的负面影响，中位数为3次访视。75%的参与者在60天和65%的参与者在90天返回了后续调查。4例（20%）患者在第100天前入住重症监护室，3例（15%）患者接受生命支持措施。5例（25%）死亡，中位随访时间为14个月。EPC是可行的，可接受的，并有可能改善HCT的经验，无论患者是否生存。HCT患者的EPC应在随机试验中进行测试。(C)2016年美国血液和骨髓移植协会。
Early palliative care (EPC) for patients with metastatic solid tumors is now standard of care, but the effect of EPC in hematopoietic cell transplantation (HCT) is less well understood. We studied the acceptability of pre-HCT EPC as measured by trial participation, changes in patient-reported outcomes, and follow-up with palliative care providers. English-speaking adults (age >17 years) with an HCT comorbidity index of >= 3, relapse risk > 25%, or planned HLA-mismatched allogeneic or myeloablative HCT received EPC before HCT admission with monthly or more frequent visits. Twenty-two (69%) of 32 subjects provided consent; 2 were later excluded (HCT cancelled, consent retracted) for a 63% participation rate. Comfort with EPC was high (82% very comfortable). Subjects reported stable or improved mood and sense of hope, without apparent negative effects with a median of 3 visits. Follow-up surveys were returned by 75% of participants at 60 days and by 65% at 90 days. Four (20%) were admitted to the intensive care unit before day 100 and 3 (15%) received life-support measures. Five (25%) died with median follow-up of 14 months. EPC is feasible, acceptable, and has the potential to improve the HCT experience, whether or not the patient survives. EPC for HCT patients should be tested in a randomized trial. (C) 2016 American Society for Blood and Marrow Transplantation.