Impact of Pediatric Palliative Care Involvement at Baseline on Symptom Burden in the First Month Following Hematopoietic Stem Cell Transplantation

Abstract

Hematopoietic Stem Cell Transplant (HSCT) is a high-stakes therapy associated with significant symptom burden. Despite known benefits of palliative care in adult HSCT, integration of pediatric palliative care (PPC) in pediatric HSCT is rare. This study investigates if baseline PPC is associated with symptom burden in the first month post-HSCT. This prospective, longitudinal cohort study at 2 pediatric centers assessed HSCT recipients with or without pre-HSCT PPC. Primary outcomes were total number of symptoms, physical symptoms, psychological symptoms, and HPQ-MSAS score at 5 timepoints in the first month reported by patients and parents. Linear mixed models provided estimated marginal means and 95% confidence intervals (CI). Propensity score regression adjustment for PPC was used to reduce confounding by indication and outcomes were compared with absolute mean differences and 95% CI. Fifty-four patients (52.9%) did not have PPC at baseline while 48 (47.1%) did. Most patients received HSCT for hematologic malignancies and patients with baseline PPC were more likely to have had prior HSCT. Total number of symptoms and HPQ-MSAS score peaked at week 1 in both groups. Across all time points, outcomes for patients with baseline PPC involvement either did not differ from, or were slightly worse than, patients without baseline PPC. None of the confidence intervals excluded the null value. Symptom burden was high among pediatric HSCT recipients. Randomized controlled trials with larger populations are needed to better assess the impact of PPC in HSCT.