Factors associated with early quality-of-life response to palliative care during hematopoietic cell transplantation.

Abstract: Limited data exist on factors associated with early quality-of-life (QOL) response to palliative care (PC) in patients undergoing hematopoietic cell transplantation (HCT). We conducted a secondary analysis from 2 randomized clinical trials of PC vs usual care in adults with hematologic malignancies undergoing HCT. We measured patient-reported QOL, physical and psychological symptoms, and coping (categorized as approach-oriented and avoidant) at the time of HCT admission and 2 weeks, 3 months, and 6 months after HCT. PC clinicians completed weekly surveys documenting PC domains addressed. We defined early QOL response to PC as the change in Functional Assessment of Cancer Therapy-Bone Marrow Transplant total score from HCT admission to week 2, using the median split to define "high" responders. A total of 252 participants were included in analyses. The median change in QOL from HCT admission to week 2 was -10.7 (range, -77.0 to +52.0). Minoritized race (odds ratio [OR], 3.2; P < .001), lower baseline QOL (OR, 0.97; P < .001), and higher physical (OR, 1.02; P = .004) and posttraumatic stress disorder symptoms (OR, 1.04; P = .008) were associated with being a high PC responder. High PC responders reported greater use of approach-oriented coping at week 2 (Δ = 2.5; P = .002) and 3 months (Δ = 1.7; P = .04) and 6 months after HCT (Δ = 2.6; P = .003). Based on PC clinician surveys during HCT, high responders' PC visits focused on coping, illness/HCT education, and symptom education, whereas low responders' visits focused on symptom management. These findings provide insights into factors associated with early QOL response to PC in HCT and help identify those most likely to benefit in real-world practice. These trials were registered at www.ClinicalTrials.gov as #NCT02207322 and #NCT03641378.