Palliative care in hematopoietic stem cell transplant recipients and impact on survival: A nationwide analysis

12129 Background: Palliative care benefits have been widely studied in solid tumors with early palliative care demonstrating prolonged survival in several malignancies including lung and esophageal cancer. There are limited data and guidelines for use of palliative care in hematopoietic stem cell transplants (HSCT). Methods: We used the National cancer database (NCDB) to identify HSCT recipients between 2004 to 2017 and retrospectively examined the outcomes based on receipt of palliative care. Chi-square and Wilcoxon tests were used to compare categorical and continuous variables respectively. Kaplan Meier analysis and a Cox multivariable proportional hazards model were used for survival analysis using R software. The NCDB is available as de-identified data. Hence, this study was exempt from a full IRB review. Results: We identified 17,464 eligible patients with hematologic malignancies who underwent HSCT during 2004-2017. The table below shows differences in baseline characteristics in patients who received palliative care vs no palliative care and shows an improved median survival in those receiving vs those not receiving (43.5 vs 31.6 months) (p = 0.0003). Patients with median household income in the lowest quartile as per 2016 survey data were taken as low-income group. A multivariable cox regression analysis that adjusted for age, sex, Charlson-Deyo Comorbidity Index, insurance status, income and Hispanic ethnicity found that integration of palliative care was associated with improved survival outcomes (HR 0.85, CI 0.77- 0.93, p = 0.0002). Conclusions: To our knowledge, this is the largest study demonstrating improved outcomes in HSCT recipients when palliative care was incorporated despite there beingmore economically challenged patients in the group that received palliative care. Although these data are retrospective and correlational, it underscores how palliative care should be incorporated as part of national society guidelines for HSCT recipients. [Table: see text]