Integrating Palliative/Supportive Care Concepts in the Blood and Marrow Transplant Setting

The availability of Blood and Marrow Transplant (BMT) can provide hope and possibly life for patients with certain acute and chronic diseases that have no hope for cure.  Unfortunately treatments that are necessary to achieve a cure can illicit untoward symptoms that seriously impact quality of life (QOL). While the goal of treatment may be cure, the challenge of treatment becomes managing the burden of those symptoms and maintaining a QOL that makes that cure worth the journey.

Symptom burden in the transplant setting presents a challenge to both the patient and the medical team.  High dose chemotherapies with high emetogenic potential can illicit severe nausea and vomiting both acute and delayed.  Some acute complications of transplant include mucositis, anorexia, pain, graft versus host disease and immunosuppression.  Acute symptoms can become chronic.  To address symptom burden it seems logical that the experts in each of these disciplines, BMT and palliative/ supportive medicine, should partner to give these patients the best possible outcome.

Obstacles to excellent palliative/supportive care in the BMT setting can occur when consults are based on clinician values, rather than patient needs.  Many clinicians mistakenly believe palliative/supportive care translates to end of life care.  The World Health Organization reports palliative/supportive care is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

The intent of this paper is to outline a proposal for the integration of palliative/supportive care concepts in the BMT setting that can facilitate the transformation of the latest knowledge into strategies that help to manage the burden of symptoms in the BMT setting.