Quality of life concerns and depression among hematopoietic stem cell transplant survivors

Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY 10022, USA.
Supportive Care in Cancer (Impact Factor: 2.36). 09/2011; 19(9):1357-65. DOI: 10.1007/s00520-010-0958-y
Source: PubMed


This study examined quality of life, transplant-related concerns, and depressive symptoms and their demographic and medical correlates at 1 to 3 years following hematopoietic stem cell transplantation (HSCT).
HSCT survivors (N=406) completed telephone-administered questionnaires that assessed demographic variables, functional status, quality of life, transplant-related concerns, and depressive symptoms.
The most prevalent concerns among HSCT survivors included physical symptoms (e.g., fatigue and pain), maintaining current health status and employment, changes in appearance, and lack of sexual interest and satisfaction. In addition, almost one-third (32%) of survivors age 40 years and younger reported concern about their ability to have children. Unemployed survivors and those with lower incomes and worse functional status were more likely to experience poorer quality of life in multiple domains. Fifteen percent of the sample reported moderate to severe depressive symptoms, and these symptoms were higher among allogeneic transplant recipients and those with lower functional status.
Results suggest that interventions are needed to address physical symptoms, coping with an uncertain future, infertility, and sexual issues during the early phase of HSCT survivorship.

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    • "For the social functioning dimension, chronic GVHD and intensity of pre-transplant conditioning were negatively associated with social functioning [20]. There have been many studies in which the relationship between psychosocial factors and post-transplant QoL of HSCT survivors has been explored [14,17,2122232425 . However , there has been less research into the association between pre-transplant QoL and psychosocial factors such as coping style, psychological distress and social support. "
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    ABSTRACT: The primary aim of this retrospective study was to determine levels of psychological distress and quality of life (QoL) immediately prior to allogeneic stem cell transplantation. The secondary aim was to examine the demographic, medical and psychosocial factors that were correlated with various QoL domains at this stage of treatment. A series of measures was completed by 122 allograft patients as part of routine psychological assessment at the treating hospital prior to undergoing the transplant. These included the Mental Adjustment to Cancer Scale, the Brief Symptom Inventory-18 and the World Health Organisation Quality of Life-BREF. Demographic and medical data were also extracted. In this study, 12% and 14% of the sample experienced significant levels of depressive and anxiety symptoms, respectively. Half of the sample reported impaired physical QoL, whereas approximately 40% reported poor psychological and social QoL. Besides relationship status, the limited number of demographic (age and gender) and medical factors (disease status) tested did not contribute significantly to reported QoL. After controlling for medical and demographic factors, weaker Fighting Spirit and higher levels of depression (trend towards significance) were associated with poorer physical and social QoL. The association among psychological distress, coping responses and QoL indicates that poor psychosocial functioning pre-transplant renders an increased likelihood of experiencing impaired QoL across various dimensions. It thus seems important that psychologically vulnerable patients are identified early in the treatment process. If psychosocial adjustment were improved, patients may experience better QoL pre-transplant with a potential subsequent influence on post-transplant outcomes. Copyright © 2013 John Wiley & Sons, Ltd.
    No preview · Article · Jun 2014 · Psycho-Oncology
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    • "In fact, it was also observed in other studies performed at various time intervals after transplantation that patients generally had low quality of life12-14, they had the lowest quality of life particularly in the second week of transplantation10 and complications and some health-related problems were experienced in the early stage (first 100 days), mid stage (100 days-1 year) and in the long-term (later than a year).11 Again in this period, patients were reported to have experienced changes in especially their physical symptoms, body images and sexual lives15-17, further worsening of their health conditions, job losses17, social problems13 and financial problems.18 In the post-transplantation period, patients commonly had fatigue11,14,15 and faced problems such as anxiety, depressive symptoms17, loss of energy, headache, dizziness19, concern for the future, and fear of relapse.13 "
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    ABSTRACT: Objective: This study was conducted thinking that it was extremely important in terms of the disease and treatment to assess the symptoms that may be encountered before and after a stem cell transplantation and quality of life. Methodology: A prospective longitudinal design was used.The study was completed in two years on 82 patients who underwent transplantation at the bone marrow transplantation unit. Data were collected using a questionnaire, the Edmonton Symptom Assessment Scale, and the Short Form-36 quality of life scale. Results: It was observed that the patients had low mean scores of physical and mental quality of life both before and after transplantation; there was an increase in the mean scores of all the symptoms and primarily of fatigue after the stem cell transplantation as compared to before it; and the mean scores of physical and mental quality of life further declined (p<0.05). Conclusion: Quality of life of patients who underwent stem cell transplantation is adversely affected in the periods immediately before and after transplantation. Patients’ quality of life worsens as the severity of symptoms experienced by patients increases.
    Full-text · Article · May 2013 · Pakistan Journal of Medical Sciences Online
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    ABSTRACT: The Internet provides a widely accessible modality for meeting survivorship care needs of cancer survivors. In this paper, we describe the development and implementation of an Internet site designed as a base from which to conduct a randomized controlled trial to meet psycho-educational needs of hematopoietic stem cell transplantation (HSCT) survivors. A cross-disciplinary team designed, wrote content, and programmed an Internet site for online study registration, consent, assessment, and study implementation. All survivors who were 3-18 years after HSCT for hematologic malignancy and treated at one transplant center were approached by mail for participation. All study activities could be conducted without study staff contact. However, participants had options for phone or email contact with study staff as desired. Of 1,775 participants approached for the study, 775 (58% of those eligible) consented and completed baseline assessment. Mean age was 51.7 (SD, 12.5; age range, 18-79 years), with 56% male. Fifty-seven percent required staff contact one or more times; a majority were for minor technical issues or delays in completion of enrollment or baseline assessment. This study demonstrated the potential for providing Internet-based survivorship care to long-term survivors of HSCT. Although building a survivorship Internet site requires a team with diverse expertise, once built, these resources can be implemented rapidly with large numbers of survivors. While Internet-based services will not meet all the needs of cancer survivors, this methodology represents an important modality for augmenting onsite clinical services as a method for meeting psycho-educational, information, and resource needs of cancer survivors.
    Full-text · Article · May 2011 · Journal of Cancer Survivorship
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