Literature Review Reveals Dearth of Information About Palliative Needs of Patients with Graft-Versus-Host Disease

Allogeneic hematopoietic stem cell transplantation (allo-HCT) often leads to severe graft-versus-host disease (GVHD), which can be life-threatening and can change the goals of care from curative to palliative. A group of researchers conducted a literature search to better understand the experiences and needs of patients who develop severe GVHD after allo-HCT. Their results were published in Cancers (Basel).

“This patient group is very heterogenous, with a high disease burden and special needs that are often overlooked,” wrote the authors, led by Freya Wenzel of the Department of Palliative Medicine at the University of Cologne in Germany.

The authors performed a focused literature search in the MEDLINE database in July 2020, with an October 2020 update. They explored whether patients with severe GVHD have special burdens or needs, as well as whether these patients have specific supportive and palliative care needs that are not being addressed.

The review identified reports published in English that explored quality of life, individual physical symptoms, physical function, psychological health, or spiritual well-being. The search uncovered only 12 studies on acute or chronic GVHD that made a distinction among the different grades of GVHD. No studies specifically explored patients with severe GVHD.

Overall, the researchers found that more severe GVHD was associated with:

  • worse quality of life
  • worse physical functioning
  • greater physical impairment
  • higher symptom burden
  • higher risk of depression
  • diminished spiritual well-being

Although the review could not determine whether specific symptoms were particularly burdensome to patients with severe GVHD, the authors noted that acute GVHD was a risk factor for fatigue and sleep disturbance. Chronic GVHD was somewhat correlated with pain syndromes, fatigue, and sexual dysfunction.

“The appraisal of available literature for this review revealed a fundamental lack of large and representative studies describing supportive and palliative care needs of patients with severe GVHD,” the authors concluded. “The relative void of data highlights the need for research on this special issue in order to optimize the treatment and care of patients with severe graft-versus-host disease.”

The authors encouraged early integration of palliative care specialists in the care of patients receiving allo-HCT. They also recommended additional research to elucidate when and how specialist palliative care services should be offered to this patient population.