Characteristics of Peri-Transplant Palliative Supportive Care Consultation Among Older Allogeneic Hematopoietic Cell Transplant Recipients

Background Recent studies have shown that provision of palliative care (PC) simultaneously with hematopoietic cell transplant (HCT) is feasible and effective in improving symptom burden and improving mood during and in the first 6 months after transplant. However, given the scarce PC resource, it is important to explore the population of HCT patients who will benefit the most from subspecialty PC and its optimal timing. Methods We retrospectively examined all peri-transplant palliative supportive care consultations for patients aged 60 years and older who underwent first allo-HCT at our institution from 2001 to 2017 through chart review. We included all PC consultations from 6 months prior to and 6 months following HCT and systemically characterized each individual consultation. Predictors and potential impact of PC consultations were analyzed. Results 70 patients (11%) among a total of 610 patients, received a PC consultation during the period and were included. Table 1 depicts the baseline clinical and transplant characteristics. The median time of PC consultation from HCT was 14.5 days and there were 9 consultations prior to HCT. The majority of PC consultation, 86%, were conducted as inpatient; and 91% were initiated by the transplant team. The primary consult reason was overwhelmingly pain management, 77%, followed by the management other symptoms, goals of care discussion, and end-of-life care. In 17 patients, 24%, additional palliative care needs were identified by the consult team. The median number of visits was 5 (range 1-23). Only three patients had outpatient follow-up after initial inpatient consultation. By June 30, 2018, 48 patients, 69%, had died. The median time from PC consultation to death was 37.5 days, with 5 patients, 10%, enrolled in hospice prior to death. We are examining independent association of pre-transplant variables with PC consultations and their impact on HCT outcomes. Conclusions While limited by its retrospective nature, this study provides an overview of PC consult utilization in an older cohort of allogeneic HCT patients, which is likely the most symptomatic population with the highest risk for adverse outcomes. These results suggest that the transplant team may not have utilized the subspecialty PC consult to its complete potential. Future studies will attempt to prospectively assess patient reported outcomes and the impact of interdisciplinary PC consult team.