Purpose Inpatient palliative care integrated with transplant care improves patients' quality of life (QOL) and symptom burden during hematopoietic stem-cell transplant (HCT). We assessed patients' mood, post-traumatic stress disorder (PTSD) symptoms, and QOL 6 months post-transplant. Methods We randomly assigned 160 patients with hematologic malignancies who underwent autologous or allogeneic HCT to inpatient palliative care integrated with transplant care (n = 81) or transplant care alone (n = 79). At baseline and 6 months post-transplant, we assessed mood, PTSD symptoms, and QOL with the Hospital Anxiety and Depression Scale and Patient Health Questionnaire, PTSD checklist, and Functional Assessment of Cancer Therapy-Bone Marrow Transplant. To assess symptom burden during HCT, we used the Edmonton Symptom Assessment Scale. We used analysis of covariance while controlling for baseline values to examine intervention effects and conducted causal mediation analyses to examine whether symptom burden or mood during HCT mediated the effect of the intervention on 6-month outcomes. Results We enrolled 160 (86%) of 186 potentially eligible patients between August 2014 and January 2016. At 6 months post-transplant, intervention participants reported lower depression symptoms on the Hospital Anxiety and Depression Scale and Patient Health Questionnaire (adjusted mean difference, -1.21 [95% CI, -2.26 to -0.16; P = .024] and -1.63 [95% CI, -3.08 to -0.19; P = .027], respectively) and lower PTSD symptoms (adjusted mean difference, -4.02; 95% CI, -7.18 to -0.86; P = .013), but no difference in QOL or anxiety. Symptom burden and anxiety during HCT hospitalization partially mediated the effect of the intervention on depression and PTSD at 6 months post-transplant. Conclusion Inpatient palliative care integrated with transplant care leads to improvements in depression and PTSD symptoms at 6 months post-transplant. Reduction in symptom burden and anxiety during HCT partially accounts for the effect of the intervention on these outcomes.

中文翻译：

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造血干细胞移植期间住院姑息治疗对移植后 6 个月心理困扰的影响：一项随机临床试验的结果

目的 住院姑息治疗与移植护理相结合，可改善造血干细胞移植 (HCT) 期间患者的生活质量 (QOL) 和症状负担。我们评估了移植后 6 个月患者的情绪、创伤后应激障碍 (PTSD) 症状和 QOL。方法 我们将 160 名接受自体或同种异体 HCT 的血液系统恶性肿瘤患者随机分配到住院姑息治疗联合移植治疗（n = 81）或单独移植治疗（n = 79）。在基线和移植后 6 个月，我们使用医院焦虑和抑郁量表和患者健康问卷、PTSD 检查表和癌症治疗 - 骨髓移植的功能评估评估了情绪、PTSD 症状和 QOL。为了评估 HCT 期间的症状负担，我们使用了埃德蒙顿症状评估量表。我们在控制基线值的同时使用协方差分析来检查干预效果，并进行因果中介分析来检查 HCT 期间的症状负担或情绪是否介导了干预对 6 个月结果的影响。结果 我们在 2014 年 8 月至 2016 年 1 月期间招募了 186 名可能符合条件的患者中的 160 名 (86%)。在移植后 6 个月，干预参与者在医院焦虑和抑郁量表和患者健康问卷中报告了较低的抑郁症状（调整后的平均差异，- 1.21 [95% CI，-2.26 至 -0.16；P = .024] 和 -1.63 [95% CI，分别为 -3.08 至 -0.19；P = .027]）和较低的 PTSD 症状（调整后的平均差异，-4.02 ；95% CI，-7.18 至 -0.86；P = .013)，但 QOL 或焦虑没有差异。HCT 住院期间的症状负担和焦虑部分介导了移植后 6 个月干预对抑郁和 PTSD 的影响。结论 住院姑息治疗与移植护理相结合，可改善移植后 6 个月的抑郁和 PTSD 症状。HCT 期间症状负担和焦虑的减少部分解释了干预对这些结果的影响。