Effect of Inpatient Palliative Care During Hematopoietic Stem-Cell Transplant on Psychological Distress 6 Months After Transplant: Results of a Randomized Clinical Trial.

Autor:	El-Jawahri A; Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH., Traeger L; Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH., Greer JA; Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH., VanDusen H; Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH., Fishman SR; Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH., LeBlanc TW; Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH., Pirl WF; Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH., Jackson VA; Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH., Telles J; Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH., Rhodes A; Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH., Li Z; Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH., Spitzer TR; Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH., McAfee S; Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH., Chen YA; Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH., Temel JS; Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH.
Jazyk:	angličtina
Zdroj:	Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2017 Nov 10; Vol. 35 (32), pp. 3714-3721. Date of Electronic Publication: 2017 Sep 19.
DOI:	10.1200/JCO.2017.73.2800
Abstrakt:	Purpose Inpatient palliative care integrated with transplant care improves patients' quality of life (QOL) and symptom burden during hematopoietic stem-cell transplant (HCT). We assessed patients' mood, post-traumatic stress disorder (PTSD) symptoms, and QOL 6 months post-transplant. Methods We randomly assigned 160 patients with hematologic malignancies who underwent autologous or allogeneic HCT to inpatient palliative care integrated with transplant care (n = 81) or transplant care alone (n = 79). At baseline and 6 months post-transplant, we assessed mood, PTSD symptoms, and QOL with the Hospital Anxiety and Depression Scale and Patient Health Questionnaire, PTSD checklist, and Functional Assessment of Cancer Therapy-Bone Marrow Transplant. To assess symptom burden during HCT, we used the Edmonton Symptom Assessment Scale. We used analysis of covariance while controlling for baseline values to examine intervention effects and conducted causal mediation analyses to examine whether symptom burden or mood during HCT mediated the effect of the intervention on 6-month outcomes. Results We enrolled 160 (86%) of 186 potentially eligible patients between August 2014 and January 2016. At 6 months post-transplant, intervention participants reported lower depression symptoms on the Hospital Anxiety and Depression Scale and Patient Health Questionnaire (adjusted mean difference, -1.21 [95% CI, -2.26 to -0.16; P = .024] and -1.63 [95% CI, -3.08 to -0.19; P = .027], respectively) and lower PTSD symptoms (adjusted mean difference, -4.02; 95% CI, -7.18 to -0.86; P = .013), but no difference in QOL or anxiety. Symptom burden and anxiety during HCT hospitalization partially mediated the effect of the intervention on depression and PTSD at 6 months post-transplant. Conclusion Inpatient palliative care integrated with transplant care leads to improvements in depression and PTSD symptoms at 6 months post-transplant. Reduction in symptom burden and anxiety during HCT partially accounts for the effect of the intervention on these outcomes.
Databáze:	MEDLINE
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