Is there a role for palliative care in CAR T-cell therapy?
Jennifer Vidrine, Joanne DroneyPurpose of review
Recent international guidelines emphasise the importance of providing palliative care to patients with haematological malignancies. Chimeric antigen receptor (CAR) T-cell therapy has transformed outcomes for patients with selected haematological malignancies, offering the possibility of durable remission or cure. This review examines the emerging role of palliative and supportive care for patients being considered for and receiving CAR T-cell therapy.
Recent findings
Recent studies highlight the distinct and significant symptom burden, treatment-related toxicities, psychological distress, financial toxicity, and caregiver impact associated with different stages of the CAR T-cell treatment journey. These findings suggest multiple opportunities for palliative and supportive care involvement during pre-treatment assessment, throughout the treatment and monitoring period, and into long-term follow-up and survivorship. Evidence from stem cell transplantation provides a strong rationale for early integrated models of palliative care in the CAR T setting.
Summary
Palliative and supportive care can support high-quality, person-centred care for patients receiving CAR T-cell therapy. Future research should focus on defining optimal integrated service models, evaluating how best to provide supportive and palliative care for patients for whom prognosis is uncertain, and establishing the optimal timing and sustainable and equitable approaches to implementation.