1614P - Integrated palliative care for patients referred for Chimeric Antigen Receptor T-cell (CAR-T) therapy: A service evaluation

Background

CAR-T therapy is potentially lifesaving for patients with certain types of refractory or relapsed lymphoma. However, patients face uncertainty about treatment outcomes and are at risk of severe toxicity. A novel integrated service was developed at our cancer centre offering patients with lymphoma being considered for CAR-T therapy a review by the Palliative Care team. The aims of this study were to describe the uptake of this service and the nature of the palliative care interventions.

Methods

Health record data was analysed for all patients with lymphoma referred for consideration of CAR-T therapy at a tertiary referral cancer centre between January 2020 and March 2022. Outcomes were recorded up to 1 year. This service evaluation was approved by the local Committee for Clinical Research.

Results

37 patient records were included. 83.8% (n=31) proceeded with CAR-T therapy. All patients had 2 or more previous lines of systemic treatment. 97.3% had an ECOG performance status of 0-1 at time of referral and median age was 66 years. Post CAR-T therapy, 35.5% had disease progression or relapse. 35.5% developed a grade 3 or 4 toxicity. 5 patients (16.1%) died, 4 due to disease progression and 4 of whom were seen by palliative care. The median time between first palliative care review and death was 133 days (range 78 - 309). Of the patients who did not proceed with CAR-T therapy, 100% (n=6) died, all due to disease progression, of whom 5 were seen by palliative care. The median time between first palliative care review and death was 18 days (range 1 - 99). In total 25 patients (67.6%) were seen by the palliative care team, of whom 40% had more than 1 consultation. The most frequent interventions were information provision (n=25), symptom control (n=13), communication (n=10) and advance care planning (n=9). Pain was the most common symptom, followed by constipation, nausea and vomiting and anxiety.

Conclusions

An integrated palliative care service is feasible within a CAR-T oncology service and is an opportunity to provide patients with information about palliative care. Development of an earlier and more integrated service can be explored. Specialist palliative care input may be required to support symptom control and advance care planning.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The Royal Marsden NHS Foundation Trust.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.