Factors associated with early quality of life response to palliative care during hematopoietic cell transplantation

• Minoritized race and worse pre-HCT quality of life and symptom burden were associated with being a high PC responder during HCT

• Coping support and HCT education are critical to PC efforts to improve quality of life during HCT

Limited data exist on factors associated with early quality of life (QOL) response to palliative care (PC) in patients undergoing hematopoietic cell transplantation (HCT). We conducted a secondary analysis from two randomized clinical trials of PC versus usual care in adults with hematologic malignancies undergoing HCT. We measured patient-reported QOL, physical and psychological symptoms, and coping (categorized as approach-oriented and avoidant) at time of HCT admission, 2-weeks, 3- and 6- months post-HCT. PC clinicians completed weekly surveys documenting PC domains addressed. We defined early QOL response to PC as change in FACT-BMT Total score from HCT admission to week 2 and used the median split to define "high" responders. 252 participants were included in analyses. The median change in QOL from HCT admission to week 2 was -10.7 (range: -77.0, +52.0). Minoritized race (OR=3.2, CI=[1.7,6.3], p<0.001), lower baseline QOL (OR=0.97, CI=[0.96,0.99], p<0.001), higher physical (OR=1.02, CI=[1.0,1.04], p=0.004) and PTSD symptoms (OR=1.04, CI=[1.01,1.07], p=0.008) were associated with being a high PC responder. High PC responders reported greater use of approach-oriented coping at week 2 (D=2.5, CI=[0.9,4.1], p=0.002), 3 months (D=1.7, CI=[0.1,3.3], p=0.04), and 6 months post-HCT (D=2.6, CI=[0.8,4.4], p=0.003). Based on PC clinician surveys during HCT, high responders' PC visits focused on coping, illness/HCT education, and symptom education, compared to low responders' visits which focused on symptom management. These findings provide insights into factors associated with early QOL response to PC in HCT and help identify those most likely to benefit in real world practice. The clinical trial were registered at clinicaltrials.gov (NCT02207322, NCT03641378)