Background Evidence suggests palliative care is often initiated late in patients with haematological malignancy; this is complicated by the challenging dichotomy of advanced disease and treatment with curative intent. Chimeric antigen receptor (CAR) T-cell therapy has recently been approved by NICE in some UK centres for diffuse large B-cell lymphoma (DLBCL) and primary mediastinal B-cell lymphoma (PMBCL) after failure of two lines of treatment. Outcomes of this group are poor and treatment may be the last hope for remission or cure. CAR T-cells are associated with unique toxicities, sometimes requiring aggressive supportive care. Little is known about the palliative care needs of these patients.
Methods Detailed quantitative and qualitative retrospective case note analysis of all patients receiving CAR T-cell infusion between January 2019 and June 2020 at the Northern Centre for Cancer Care, Newcastle-Upon-Tyne.
Results 33 patients received CAR T-cell therapy. Overall, symptom burden was significant. Four core symptoms were assessed: nausea/vomiting, pain, dyspnoea, and anxiety/psychological distress. All patients experienced at least one symptom, and 82% of patients experienced two or more symptoms.
6 month mortality was high (51%). A third of patients were admitted to Intensive Care due to treatment toxicity and this group had a higher mortality (64%). 8 patients were referred to the palliative care service during admission. Of the 8 patients seen by palliative care, 7 had evidence of advance care planning (ACP). There was no evidence of ACP for the patients who died without palliative care input.
Conclusions Patients undergoing CAR T-cell therapy for DLBCL/PMBCL have evidence of unmet palliative care needs with significant symptom burden and high mortality. The added challenge of many patients travelling from outside the region for treatment may be a barrier to initiation of ACP. More work is needed on the impact of integrated, upstream palliative care in this group.
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