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Quality of Life

Patient-rated emotional and physical functioning among hematologic cancer patients during hospitalization for stem-cell transplantation

Summary:

In this 3-year prospective inpatient study, 220 patients received stem-cell transplantation (SCT) for hematologic cancer at a single institution. The objective of the study is to provide data on patient-rated emotional (depression and anxiety) and physical (overall physical status, energy level, and systemic symptomatology) functioning during hospitalization for SCT and to compare whether these differ between autologous and allogeneic SCT. Patients were assessed at hospital admission (T1), day of SCT (T2), and 7 days (T3) and 14 days (T4) after SCT, yielding a total of 852 evaluations. For the overall sample, anxiety was highest at T1 and decreased afterwards; a marked worsening in physical health status variables corresponded with a sharp increase in depression from T1 to T3, and was followed by an improvement in physical health and a reduction of depression. Compared to allogeneic SCT, a better physical outcome for autologous SCT was demonstrated by the significant group effect for systemic symptomatology and by the significant group × time interaction for overall physical status and energy level; there were no significant differences in depression or anxiety between SCT groups. These findings have implications for treatment decision making, coping with the transplantation process, and improving prevention and treatment strategies.

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References

  1. Gratwohl A, Baldomero H, Passweg J et al. Hematopoietic stem cell transplantation for hematological malignancies in Europe. Leukemia 2003; 7: 941–959.

    Article  Google Scholar 

  2. Lennard AL, Jackson GH . Stem cell transplantation. BMJ 2000; 321: 433–437.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Neitzert CS, Ritvo P, Dancey J et al. The psychosocial impact of bone marrow transplantation: a review of the literature. Bone Marrow Transplant 1998; 22: 409–422.

    Article  CAS  PubMed  Google Scholar 

  4. Meyers CA, Weitzner M, Byrne K et al. Evaluation of the neurobehavioral functioning of patients before, during, and after bone marrow transplantation. J Clin Oncol 1994; 12: 820–826.

    Article  CAS  PubMed  Google Scholar 

  5. Ahles TA, Tope DM, Furstenberg C et al. Psychologic and neuropsychologic impact of autologous bone marrow transplantation. J Clin Oncol 1996; 14: 1457–1462.

    Article  CAS  PubMed  Google Scholar 

  6. Hann DM, Garovoy N, Finkelstein B et al. Fatigue and quality of life in breast cancer patients undergoing autologous stem cell transplantation: a longitudinal comparative study. J Pain Symptom Manage 1999; 17: 311–319.

    Article  CAS  PubMed  Google Scholar 

  7. Chapko MK, Syrjala KL, Schilter L et al. Chemoradiotherapy toxicity during bone marrow transplantation: time course and variation in pain and nausea. Bone Marrow Transplant 1989; 4: 181–186.

    CAS  PubMed  Google Scholar 

  8. Fife BL, Huster GA, Cornetta KG et al. Longitudinal study of adaptation to the stress of bone marrow transplantation. J Clin Oncol 2000; 18: 1539–1549.

    Article  CAS  PubMed  Google Scholar 

  9. Lee SJ, Fairclough D, Parsons SK et al. Recovery after stem-cell transplantation for hematologic diseases. J Clin Oncol 2001; 19: 242–252.

    Article  CAS  PubMed  Google Scholar 

  10. Hjermstad MJ, Loge JH, Evensen SA et al. The course of anxiety and depression during the first year after allogeneic or autologous stem cell transplantation. Bone Marrow Transplant 1999; 24: 1219–1228.

    Article  CAS  PubMed  Google Scholar 

  11. McQuellon RP, Russell GB, Rambo TD et al. Quality of life and psychological distress of bone marrow transplant recipients: the ‘time trajectory’ to recovery over the first year. Bone Marrow Transplant 1998; 21: 477–486.

    Article  CAS  PubMed  Google Scholar 

  12. Leigh S, Wilson KC, Burns R et al. Psychosocial morbidity in bone marrow transplant recipients: a prospective study. Bone Marrow Transplant 1995; 16: 635–640.

    CAS  PubMed  Google Scholar 

  13. Broers S, Kaptein AA, Le Cessie S et al. Psychological functioning and quality of life following bone marrow transplantation: a 3-year follow-up study. J Psychosom Res 2000; 48: 11–21.

    Article  CAS  PubMed  Google Scholar 

  14. Loberiza FR, Rizzo JD, Bredeson CN et al. Association of depressive syndrome and early deaths among patients after stem-cell transplantation for malignant diseases. J Clin Oncol 2002; 20: 2118–2126.

    Article  PubMed  Google Scholar 

  15. Prieto JM, Blanch J, Atala J et al. Psychometric study of quality of life instruments used during hospitalization for stem cell transplantation. J Psychosom Res 2004; 57: 201–211.

    Article  PubMed  Google Scholar 

  16. Nunnally JC . Psychometric Theory. McGraw Hill: New York, 1978.

    Google Scholar 

  17. Lesko LM . Bone marrow transplantation. In: Holland JC, Rowland JH (eds.) Handbook of Psychooncology. Oxford University Press: New York, 1990; pp 163–173.

    Google Scholar 

  18. Gaston-Johansson F, Franco T, Zimmerman L . Pain and psychological distress in patients undergoing autologous bone marrow transplantation. Oncol Nurs Forum 1992; 1: 41–48.

    Google Scholar 

  19. Zigmond AS, Snaith RP . The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67: 361–370.

    Article  CAS  PubMed  Google Scholar 

  20. Bjelland I, Dahl AA, Haug TT et al. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 2002; 52: 69–77.

    Article  PubMed  Google Scholar 

  21. Herrmann C . International experiences with the Hospital Anxiety and Depression Scale – a review of validation data and clinical results. J Psychosom Res 1997; 42: 17–41.

    Article  CAS  PubMed  Google Scholar 

  22. Prieto JM, Blanch J, Atala J et al. Psychiatric morbidity and impact on hospital length of stay among hematologic cancer patients receiving stem-cell transplantation. J Clin Oncol 2002; 20: 1907–1917.

    Article  PubMed  Google Scholar 

  23. Karnofsky DA, Burchenal JH . The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod CM (ed.) Evaluation of Chemotherapeutic Agents. Columbia University Press: New York, 1949; pp 199–205.

    Google Scholar 

  24. Hunt SM, McKenna SP, McEwen J et al. The Nottingham Health Profile: subjective health status and medical consultations. Soc Sci Med 1981; 15 (Suppl. A): 221–229.

    CAS  Google Scholar 

  25. Derogatis LR . The Psychosocial Adjustment to Illness Scale (PAIS). J Psychosom Res 1986; 30: 77–91.

    Article  CAS  PubMed  Google Scholar 

  26. Stark DPH, House A . Anxiety in cancer patients. Br J Cancer 2000; 83: 1261–1267.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Schulz-Kindermann F, Hennings U, Ramm G et al. The role of biomedical and psychosocial factors for the prediction of pain and distress in patients undergoing high-dose therapy and BMT/PBSCT. Bone Marrow Transplant 2002; 29: 341–351.

    Article  CAS  PubMed  Google Scholar 

  28. Stark D, Kiely M, Smith A et al. Anxiety disorders in cancer patients: their nature, associations, and relation to quality of life. J Clin Oncol 2002; 20: 3137–3148.

    Article  CAS  PubMed  Google Scholar 

  29. Aass N, Fossa SD, Dahl AA et al. Prevalence of anxiety and depression in cancer patients seen at the Norwegian Radium Hospital. Eur J Cancer 1997; 33: 1597–1604.

    Article  CAS  PubMed  Google Scholar 

  30. Harter M, Reuter K, Aschenbrenner A et al. Psychiatric disorders and associated factors in cancer: results of an interview study with patients in inpatient, rehabilitation and outpatient treatment. Eur J Cancer 2001; 37: 1385–1393.

    Article  CAS  PubMed  Google Scholar 

  31. Baker F, Marcellus D, Zabora J et al. Psychological distress among adult patients being evaluated for bone marrow transplantation. Psychosomatics 1997; 38: 10–19.

    Article  CAS  PubMed  Google Scholar 

  32. Hjermstad MJ, Fayers PM, Bjordal K et al. Health-related quality of life in the general Norwegian population assessed by the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire: the QLQ=C30 (+3). J Clin Oncol 1998; 16: 1188–1196.

    Article  CAS  PubMed  Google Scholar 

  33. Jenkinson C, Coulter A, Wright L . Short form 36 (SF36) health survey questionnaire: normative data for adults of working age. BMJ 1993; 306: 1437–1440.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Ahlberg K, Ekman T, Gaston-Johansson et al. Assessment and management of cancer-related fatigue in adults. Lancet 2003; 362: 640–650.

    Article  PubMed  Google Scholar 

  35. Stasi R, Abriani L, Beccaglia P et al. Cancer-related fatigue: evolving concepts in evaluation and treatment. Cancer 2003; 98: 1786–1801.

    Article  PubMed  Google Scholar 

  36. Massie MJ, Popkin MK . Depressive disorders. In Holland JC (ed.) Psycho-oncology. Oxford University Press: New York, 1998; pp 518–540.

    Google Scholar 

  37. Noyes R, Holt CS, Massie MJ . Anxiety disorders. In: Holland JC (ed.) Psycho-oncology. Oxford University Press: New York, 1998; pp 548–563.

    Google Scholar 

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Acknowledgements

We thank the patients who, by participating in this study, have contributed to a better understanding of the effects of cancer and SCT on emotional status and QOL. We also thank the medical and nursing staff from the SCT Unit for providing medical information, and Llorenç Badiella, Statistical and Consulting Service, Universitat Autònoma de Barcelona, for his assistance with the data analysis. This study was supported by research Grant FIJC 98/QV-JMP from the Josep Carreras International Leukemia Foundation. The funding organization had no role in the design, conduct, interpretation, and analysis of the study and review or approval of the manuscript.

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Prieto, J., Atala, J., Blanch, J. et al. Patient-rated emotional and physical functioning among hematologic cancer patients during hospitalization for stem-cell transplantation. Bone Marrow Transplant 35, 307–314 (2005). https://doi.org/10.1038/sj.bmt.1704788

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