Palliative Care of Hematopoietic Cell Transplant Recipients and Families

https://doi.org/10.1016/j.soncn.2014.08.007Get rights and content

Objectives

To provide support for the early integration of palliative care into the care of hematopoietic cell transplant (HCT) recipients and families with the goal of improving care.

Data Sources

Journal articles and on-line databases.

Conclusion

Early integration of palliative care for HCT recipients at high risk for complex symptom clusters, non-relapse mortality, or relapse offers an opportunity to clarify goals of care, advanced care planning, and improving the quality of care for both recipients and families.

Implications for Nursing Practice

The palliative care service can support the HCT nurse in providing complex care to HCT recipients who are faced with significant side effects, toxicities, and complications of transplant.

Section snippets

Palliative Care Models

Palliative care is defined as specialized interdisciplinary care for patients with serious illness that focuses on relief of symptoms and psychological distress.10 Palliative care has been endorsed as a best practice in oncology by the American Society of Clinical Oncology and is incorporated into the clinical practice guidelines of the European Society for Medical Oncology and the Society for Surgical Oncology.11 It is recommended that palliative care be delivered within the continuum of

High-dose Conditioning Therapy Sequelae

Care of HCT recipients and families is delivered by a multidisciplinary HCT team that delivers primary palliative care focused on curing the underlying illness, symptom management, and psychological support. Conditioning regimens for HCT range in intensity from ablative therapy utilizing high-dose therapy to reduced-intensity conditioning regimens utilizing lower doses of cytotoxic therapy or therapy aimed primarily at immunosuppression. High-dose conditioning regimens utilized to prepare HCT

Outcomes of Hematopoietic Cell Transplantation

Variables impacting outcomes include age, co-morbid conditions, disease, disease stage, prior therapies, type of donor, degree of donor-recipient matching, type of transplant, and intensity of the conditioning regimen. Table 1, Table 2 review 3-year probabilities of survival following HCT based on disease status and type of transplant.19 In general, outcomes are best when the disease is in remission and poor in the setting of relapsed or refractory disease. Early integration of palliative care

Intensive Care Utilization Project

The transfer of a critically ill HCT recipient to the intensive care unit (ICU) is a complicated and difficult decision. Both physicians and patients approach HCT with the goal of cure. For patients, HCT often represents their last curative option and they are willing to accept significant risks to achieve that goal. For patients and families the decision to transfer to the ICU is fraught with the fear of dying, concerns of pain and suffering, and the need to push forward toward a cure at all

Outcomes of the ICU Utilization Project

Figure 2 shows the number of HCT recipients transferred to the ICU under each of the three categories. One goal of this project was to minimize the number of patients transferred to the ICU when they fell into the category of “no ICU recommended.” For the past 7 years, one to three patients a year were sent to the ICU even though, based on the guidelines, transfer to the ICU was not recommended. In reviewing these cases, some were patients or families that wanted “everything done,” they were

Conclusion

HCT is an aggressive medical treatment that offers curative therapy for many malignant and non-malignant diseases. The high-dose conditioning regimens and transplant complications, such as GVHD, result in significant side effects, toxicities, and physical and emotional suffering. HCT nurses are experts in primary palliative care, intervening to reduce physical and emotional distress across the long and uncertain transplant trajectory. For those HCT recipients with complex symptoms, poor coping

D. Kathryn Tierney, RN, PhD: Oncology Clinical Nurse Specialist, Blood and Marrow Transplant Program, Stanford University Medical Center, Stanford, CA.

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    • Cited by (7)

    View all citing articles on Scopus

    D. Kathryn Tierney, RN, PhD: Oncology Clinical Nurse Specialist, Blood and Marrow Transplant Program, Stanford University Medical Center, Stanford, CA.

    Judy Passaglia, RN, MS, ACHPN: Manager Palliative Medicine, Stanford University Medical Center, Stanford, CA.

    Patricia Jenkins, RN, MPA: Patient Care Manager, Blood and Marrow Transplant Program, Stanford University Medical Center, Stanford, CA.

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