Defining the Role of Palliative care for Patients with Hematologic Malignancies Undergoing Adoptive Cellular Therapy

PROJECT SUMMARY Adoptive cellular therapies (ACT) such as chimeric antigen receptor T-cell therapy are complex treatments for patients with hematologic malignancies. Patients receiving ACT can experience life-threatening toxicities, which result in tremendous symptom burden and creates substantial burden for their caregivers. Moreover, patients receiving ACT experience intense healthcare utilization at the end of life (EOL) with 50% dying in the hospital. Thus, interventions are needed to optimize the quality of life (QOL) and EOL care for patients receiving ACT and improve the QOL of their caregivers. Prior studies have shown that involving specialty palliative care (PC) clinicians in the care of patients with solid tumors and hematologic malignancies improves a wide range of outcomes for patients and their caregivers. Yet PC clinicians are rarely consulted in the care of patients receiving ACT. Furthermore, these patients have unique needs and illness trajectory and prior PC interventions in oncology are not tailored for this population. We recently completed a longitudinal study to comprehensively delineate the needs of patients receiving ACT and utilized these data to develop a PC intervention (PEACE) tailored to this population. This proposal details a five-year plan to refine and pilot test PEACE to address the unmet needs of patients receiving ACT and their caregivers. Specifically, the aims of this project are to 1) refine PEACE based on findings from an open pilot study (N=15) of patients with hematologic malignancies undergoing ACT and their caregivers; 2) determine the feasibility and acceptability of PEACE by conducting a pilot randomized controlled trial (RCT) (N = 80), and 3) explore the preliminary effects of PEACE for improving the QOL, physical and psychological symptoms, prognostic understanding, and EOL communication of patients receiving ACT and the QOL, psychological symptoms, and prognostic understanding of their caregivers. This work will lay the foundation to demonstrate the role of PC for improving the quality of care and lived experience of patients receiving ACT. This proposal also details the plans of the candidate, Dr. P. Connor Johnson, a medical oncologist physician- investigator specializing in ACT, to gain mentorship, didactic training, and career development to facilitate his transition to research independence. Dr. Johnson’s long-term career goal is to become a leader in supportive care oncology research, specializing in developing and evaluating interventions to improve the QOL and care of patients receiving ACT. This proposal includes Dr. Johnson’s plans for gaining expertise in 1) refining and testing supportive care interventions; 2) adapting PC interventions to the unique needs of patients receiving ACT and their caregivers; and 3) conducting and evaluating outcomes in supportive care clinical trials. He will achieve this training through experiential learning leading the proposed project with guidance from his mentor Dr. Areej El- Jawahri, a leading expert in PC research, and a scientific advisory team with expertise in PC research, qualitative research methods, ACT clinical care and research, EOL communication, monitoring intervention fidelity, and RCT outcome evaluation. He will gain additional skills through coursework in PC and RCT design and conduct. This project will position Dr. Johnson to compete for R01-level funding and launch an independent career leading a research program at the interface of supportive care and ACT.