IMPORTANCEDuring 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 followup, 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,loweranxiety,nodifferenceinfatigue,andlessincreaseinsymptomburden.At3months, 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). Patient Outcomes Mean Score at Week 2 Mean Difference Between Groups (95% CI) P Value Standard Care Palliative Care Quality of life (change from baseline) −21.54 −14.72 −6.82 (−13.48 to −0.16) .045 Fatigue −13.65 −10.30 −3.34 (−7.25 to 0.56) .09 Symptom burden 23.14 17.35 5.80 (0.49 to 11.10) .03 Depression 3.92 2.43 1.49 (0.20 to 2.78) .02 Anxiety 1.12 −0.80 1.92 (0.83 to 3.01) <.001CONCLUSIONS 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.

Background To investigate the impact of hospitalization for hematopoietic stem cell transplantation (HCT) on patients’ and family caregivers’ (FC) quality of life (QOL) and mood. Methods We conducted a longitudinal study of patients hospitalized for HCT and their FC. At baseline (6 days pre-HCT), day+1, and day+8 of HCT, we assessed QOL (Functional Assessment of Cancer Therapy-Bone Marrow Transplantation FACT-BMT), and mood (Hospital Anxiety and Depression Scale HADS). We administered the SF-36 to examine FC QOL [physical component scale (PCS), and mental component scale (MCS)]. To identify predictors of QOL changes, we used multivariable linear mixed models. Results We enrolled 97% of eligible patients undergoing autologous (n=30), myeloablative (n=30) or reduced intensity (n=30) allogeneic HCT. Patients’ QOL markedly declined (mean FACT-BMT 109.6 to 96.0, P < 0.0001) throughout hospitalization. The proportion of patients with depression (HADS-Depression> 7) more than doubled from baseline to day+8 (15.6% to 37.8%, P < 0.0001), whereas the proportion of patients with anxiety remained stable (22.2%, P = 0.8). These results remained consistent when data were stratified by HCT type. Baseline depression (β= −2.24, F=42.2, p < 0.0001) and anxiety (β= −0.63, F=4.4, p = 0.03) independently predicted worse QOL throughout hospitalization. FC QOL declined during patient’s hospitalization (PCS: 83.1 to 79.6, P= 0.03, MCS: 71.6 to 67.4, P = 0.04). Conclusions Patients undergoing HCT reported a steep deterioration in QOL and substantially worsening depression during hospitalization. Baseline anxiety and depression predicted worse QOL during hospitalization, underscoring the importance of assessing pre-HCT psychiatric morbidity.

This article reports a single‐center randomized clinical trial that evaluated the effect of early integrated specialty palliative care on patient‐ and caregiver‐reported outcomes in patients with newly‐diagnosed, incurable cancers. It was hypothesized that caregivers of patients assigned to early integrated palliative care would report lower psychological distress and better quality of life compared with caregivers of patients assigned to usual oncology care.