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Fatigue predicts impaired social adjustment in survivors of allogeneic hematopoietic cell transplantation (HCT)

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Abstract

Purpose

The aim of this study is to examine social adjustment to illness and to identify factors related to social adjustment in allogeneic hematopoietic cell transplantation (HCT) survivors.

Methods

Cross-sectional data were drawn from a longitudinal study of patients ≥ 3 years after their first HCT. The five subscales of the Psychosocial Adjustment to Illness Scale (PAIS) that reflect social adjustment, specifically vocational environment (VE); domestic environment (DE); sexual relationships (SEX); extended family relationships (ER); and social environment (SE) were examined in this analysis. Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) measured cancer-related fatigue.

Results

Subjects (N = 171) were a median of 5.19 years from HCT (range 3–16). The most impaired dimension of social adjustment was ER with 38% of participants reaching clinically relevant (score ≥ 62) levels of social maladjustment. Unmarried and unemployed participants had lower levels of social adjustment in VE (p < .001 and p < .001, respectively) and DE (p = .004 and p = .006, respectively). Survivors with some college had poorer SEX adjustment than those with less or more education (p < .005). Hispanics reported lower adjustment with respect to ER adjustment (p = .002). Participants with higher fatigue had poorer adjustment in all five dimensions (p < .001).

Conclusions

Although the majority of survivors are well adjusted, subgroups may experience significant poor social adjustment. Specifically, survivors with fatigue are at risk to experience lower levels of social adjustment. Development of effective rehabilitation strategies to improve affected areas of social health is warranted, and all HCT survivors should be screened periodically for social maladjustment and provided with resources and referrals.

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Acknowledgements

The authors thank Stephen Klagholz, BS; Lisa Cook, RN, MSN; Eleftheria Koklanaris, RN, BSN, OCN®; Bazetta B. Schuver, RN, BSN; Patricia Prince, MEd, MSW; Kathleen Castro, RN, MS, AOCN®; Michael Krumlauf, RN, BSN, OCN®; Georgie Cusack, MS, RN, AOCNS®; Bipin Savani, MD; Daniel H. Fowler, MD; Richard Childs, MD; John A. Barrett, MD; Gwenyth Wallen, RN, PhD; the NCI and NHLBI Intramural Research Transplant Teams; the NIH Clinical Center staff, and research participants.

Funding

This research was funded by the Intramural Research Program at the National Institutes of Health, Clinical Center.

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Authors and Affiliations

  1. National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD, 20892-1151, USA

    Jumin Park, Leslie Wehrlen, Li Yang & Margaret F. Bevans

  2. National Cancer Institute, Division of Cancer Control and Population Sciences, Outcomes Research Branch, Rockville, MD, USA

    Sandra A. Mitchell

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  1. Jumin Park
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  2. Leslie Wehrlen
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  3. Sandra A. Mitchell
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  4. Li Yang
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  5. Margaret F. Bevans
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Correspondence to Margaret F. Bevans.

Ethics declarations

All patients provided written informed consent before participation, which was approved by the National Heart, Lung and Blood Institute Intramural Institutional Review Board (NCT00128960).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the National Heart, Lung and Blood Institute Intramural Institutional Review Board (NCT00128960).

Informed consent

Informed consent was obtained from all individual participants included in this study.

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Park, J., Wehrlen, L., Mitchell, S.A. et al. Fatigue predicts impaired social adjustment in survivors of allogeneic hematopoietic cell transplantation (HCT). Support Care Cancer 27, 1355–1363 (2019). https://doi.org/10.1007/s00520-018-4411-y

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  • DOI: https://doi.org/10.1007/s00520-018-4411-y

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