What Is the Role of Palliative Care in Pediatric Patients with Blood Cancers?

Early integration of consults with a palliative care team (PaCT) could decrease symptom burden and distress for pediatric patients with blood cancers receiving hematopoietic stem cell transplantation (HSCT), according to a study presented at the 2024 ASPHO meeting.

The study, led by Meagan Vacek, DO, of Children’s Mercy Hospital, aimed to increase the number of PaCT consults for patients receiving HSCT for targeted diagnoses from 48% to 75% by December 2023. Targeted diagnoses included relapsed or refractory leukemias and lymphomas, myelodysplastic syndromes, high-risk myeloid leukemias, and metabolic disorders such as Hurler syndrome.

The researchers conducted a chart review for 48 patients who underwent HSCT from July 2020 to July 2022, then utilized a plan-do-study act (PDSA) method. Of the 48 patients, 25 had a targeted diagnosis.

The first PDSA cycle consisted of increasing communication and education at division meetings about palliative care and its involvement in HSCT patients. The second cycle involved adding the question, “Is PaCT consulted?” to the HSCT referral form. The PaCT also attended weekly transplant team meetings to discuss current and upcoming patients.

Between July 2020 and July 2022, the PaCT met 12 of 25 patients (48%) who had a targeted diagnosis. Of 14 patients with a targeted diagnosis who underwent HSCT from January 2023 to November 2023, eight (57%) received a PaCT consult.

“Palliative care facilitates communication, helps with physical and psychological symptom management, and assists in goals of care and advance care planning discussions,” Dr. Vacek and colleagues wrote. “Future PDSA cycles to further increase involvement include adding PaCT consultation to the transplant evaluation order set in the electronic medical record and review of the comments on the completed HSCT referral forms to identify possible barriers in the PaCT consultation process.”

Reference

Vacek M, Tarbell L, List M, et al. Increasing palliative care team involvement in pediatric hematopoietic stem cell transplant patients. Poster #410. Presented at the 2024 American Society of Pediatric Hematology/Oncology Conference; April 3–6, 2024; Seattle, Washington.