Areej El-Jawahri, MD, discusses the potential benefits of earlier palliative care for patients with hematologic malignancies.

Dr El-Jawahri on the Benefits of Earlier Palliative Care in Hematologic Malignancies

Areej El-Jawahri, MD, associate director, Cancer Outcomes Research and Education Program, director, Bone Marrow Transplant Survivorship Program, associate professor, medicine, Massachusetts General Hospital, discusses the potential benefits of incorporating palliative care approaches earlier in the treatment course for patients with hematologic malignancies.

El-Jawahri and colleagues conducted a multi-site, randomized trial (NCT03310918) comparing outcomes with a collaborative palliative and oncology care model vs usual care in patients diagnosed with acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS) receiving nonintensive therapy at 2 tertiary care academic hospitals (n = 115).

Results presented at the 2024 ASCO Annual Meeting highlighted critical differences in end-of-life care delivery and quality of life (QOL) between the two care models. Patients who received the palliative care interventions exhibited markedly improved end-of-life planning and QOL outcomes vs the standard care group. Furthermore, patients experienced a trend toward reduced anxiety symptoms with palliative care vs usual care.

Growing evidence has demonstrated the benefits of integrating palliative care into oncology beyond end-of-life support, El-Jawahri begins. In addition to the data presented at the 2024 ASCO Annual Meeting, 4 other randomized clinical trials have shown how early palliative care integration can significantly affect a range of patient- and caregiver-reported outcomes, particularly in patients receiving curative treatments, she reports.

Palliative care is often misperceived as synonymous with end-of-life care, but it plays a crucial role much earlier in the treatment journey, El-Jawahri continues. These studies highlight that the integration of palliative care can benefit patients undergoing intensive therapies, such as chemotherapy for leukemia or stem cell transplants, by improving their overall QOL and addressing symptoms like fatigue and pain, she states. Beyond immediate symptom relief, palliative care has been shown to improve long-term survivorship, El-Jawahri adds. Patients receiving palliative care also report lower rates of depression and post-traumatic stress, she notes.

Overall, this study is part of a larger body of research that underscores the broader applications of palliative care, El-Jawahri emphasizes. The evidence suggests that integrating palliative care earlier in the treatment process, particularly with the involvement of specialized clinicians, could significantly enhance the care of patients with hematologic malignancies, she concludes.

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Dr El-Jawahri on the Effects of Sexual Health Interventions in HSCT Recipients

Areej El-Jawahri, MD, associate director, Cancer Outcomes Research and Education Program, director, Bone Marrow Transplant Survivorship Program, associate professor, medicine, Massachusetts General Hospital, discusses findings from a randomized trial investigating a multimodal intervention to enhance sexual function and quality of life (QOL) in patients who previously received hematopoietic stem cell transplant (HSCT). 

This single center trial aimed to address issues of sexual dysfunction in survivors of allogeneic and autologous HSCT who had received transplant at least 3 months prior to enrolling in the study and had noted that they were experiencing sexual dysfunction that caused distress. Patients were randomly assigned to receive sexual health interventions (n = 64) or usual care (n = 61). Patients in the intervention arm met with a trained HSCT clinician 3 times a month to assess the causes of their sexual dysfunction, receive education to address their sexual health concerns, and implement therapeutic interventions. The primary end point was the comparison of global satisfaction with sex at 3 months between the 2 arms.

Patients who saw transplant clinicians who were trained in addressing sexual health issues experienced improved sexual health outcomes, including global satisfaction with sex (B = 4.7; 

 < .001), and sexual function, compared with patients who did not see these specialists. Furthermore, patients who were treated by clinicians trained in addressing sexual health issues had improvements in QOL (B = 12.5; 

 = .003) and depression symptoms (B = –2.0; 

 < .001). Based on these findings, El-Jawahri notes that further research is needed to determine the extent to which the improvements in sexual health outcomes directly affected QOL and mood in this population.

Investigators observed the effects of the sexual health interventions beyond the 3-month period during which patients actively received these interventions. These patients continued to report improved sexual health, QOL, and mood, El-Jawahri concludes.

Areej El-Jawahri, MD, discusses a trial investigating a multimodal intervention to enhance sexual function in patients who have previously received HSCT. 

Dr El-Jawahri on the Impact of Palliative Care on End-of-Life Care for AML and MDS

Areej El-Jawahri, MD, associate director, Cancer Outcomes Research and Education Program, director, Bone Marrow Transplant Survivorship Program, associate professor, medicine, Massachusetts General Hospital, discusses findings from a multi-site, randomized trial (NCT03310918) investigating a collaborative palliative oncology care model for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) receiving nonintensive therapy at 2 tertiary care academic hospitals.

This study compared the effects of a collaborative palliative and oncology care model on end-of-life care delivery and quality of life (QOL) vs usual care in 115 adult patients with AML and high-risk MDS. Patients who were randomly assigned to the interventional arm met with a palliative care clinician monthly in the outpatient setting and at least twice a week during every hospital admission.

Patients in the study who received the palliative care interventions had a median of 41 days from end-of-life care discussions to death, compared with 1.5 days in the standard care group (

 < .001). Additionally, patients who received the palliative care interventions were more likely to articulate their end-of-life care preferences and have these preferences documented in electronic health records, El-Jawahri begins. This documentation correlated with fewer hospitalizations in the final 30 days of life, she notes. Furthermore, palliative care recipients experienced QOL improvements and a trend toward reduced anxiety symptoms vs the patients who received usual care, El-Jawahri says.

These findings underscore the necessity of integrating palliative care as a standard of care for patients with AML and high-risk MDS, El-Jawahri emphasizes. Evidence from multiple clinical trials confirms that palliative care enhances patient outcomes by improving QOL, addressing physical and psychological symptoms, and refining end-of-life care delivery, she explains. The challenge now lies in effectively incorporating palliative care into oncology practices and addressing the limited availability of specialty palliative care clinicians, El-Jawahri reports.

The oncology field needs to identify the components of palliative care that most significantly impact patient outcomes, according to El-Jawahri. By understanding these components, oncology practices can incorporate them into primary care delivery for patients and families, ensuring all patients experience benefit, she concludes.

Areej El-Jawahri, MD, discusses a trial investigating a palliative oncology care model for patients with AML and MDS receiving nonintensive therapy.

Areej R. El-Jawahri, MD, assistant in Medicine, Massachusetts General Hospital, instructor in Medicine, Harvard Medical School, discusses the impact of palliative care on patients and family caregivers.

Palliative care focuses on multiple domains to improve family and patient care. These include symptom control and how patients and family cope with their illness and better understand it.

Most quality-of-life improvements for patients are related to symptom management and coping techniques, says El-Jawahri. The caregivers also experience benefit by attending palliative care visits and learning tatics to cope with the their loved one's cancer, which can really take a toil on the entire family, she says.

Dr. Areej El-Jawahri on the Impact of Palliative Care

Areej R. El-Jawahri, MD, assistant in Medicine, Massachusetts General Hospital, instructor in Medicine, Harvard Medical School, discusses a study examining early integrated palliative care for patients with gastrointestinal (GI) or lung cancer and the impact it has on their family caregivers.

Family caregivers play a significant role in caring for patients with advanced cancer; however, they experience a deterioration in their quality of life, El-Jawahri explains. Prior studies show that early integration of palliative care leads to improved quality of life, symptom burden, and quality of end-of-life care for patients. However, it was unknown what impact such care has on family caregiver outcomes.

In this study, patients were randomized to receive the integrated palliative care from time of diagnosis, along with standard care. Results showed that family caregivers of the patients who were randomized to the intervention had improvement in aspects of their quality of life, including vitality, social function, and depression at 12-weeks post-intervention.

Areej R. El-Jawahri, MD, assistant in Medicine, Massachusetts General Hospital, instructor in Medicine, Harvard Medical School, discusses a study examining early integrated palliative care for patients with gastrointestinal (GI) or lung cancer and the impact it has on family caregiver outcomes.

Areej R. El-Jawahri, MD

Articles

Dr El-Jawahri on the Benefits of Earlier Palliative Care in Hematologic Malignancies

Dr El-Jawahri on the Effects of Sexual Health Interventions in HSCT Recipients

Dr El-Jawahri on the Impact of Palliative Care on End-of-Life Care for AML and MDS

Dr. Areej El-Jawahri on the Impact of Palliative Care

Dr. El-Jawahri on Early Integrated Palliative Care in Patients With Lung or GI Cancer