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Amonoo HL, Newcomb R, Lorenz KA, Psenka R, Holmbeck K, Farnam EJ, Tse A, Desai S, Vassev N, Waldman LP, El-Jawahri A. A novel psychosocial virtual reality intervention (BMT-VR) for patients undergoing hematopoietic stem cell transplantation: Pilot randomized clinical trial design and methods. Contemp Clin Trials 2024; 142:107550. [PMID: 38685401 PMCID: PMC11180582 DOI: 10.1016/j.cct.2024.107550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Although patients undergoing hematopoietic stem cell transplantation (HSCT) must cope with psychological distress and isolation during an extended transplant hospitalization, psychosocial interventions to address these unmet needs are lacking. Virtual reality offers an innovative modality to deliver a patient-centered psychosocial intervention to address psychosocial needs of patients undergoing HSCT. However, there are currently no supportive care interventions leveraging virtual reality in patients undergoing HSCT. OBJECTIVE To describe the methods of a randomized clinical trial (RCT) to assess the feasibility and preliminary efficacy of a self-administered, virtual reality-delivered psychosocial intervention (BMT-VR) to improve psychological distress and quality of life (QOL) for patients hospitalized for HSCT. METHODS This study entails a single-center RCT of BMT-VR compared to usual transplant care in 80 patients hospitalized for HSCT. Adult patients with hematologic malignancies hospitalized for autologous or allogeneic HSCT are eligible. BMT-VR includes psychoeducation about the HSCT process, psychosocial skill building to promote effective coping and acceptance, and self-care and positive psychology skills to promote post-HSCT recovery. The primary aim is to assess the feasibility defined a priori as ≥60% of eligible patients enrolling in the study, and of those enrolled and randomized to the BMT-VR, ≥ 60% completing 4/6 BMT-VR modules. Secondary objectives include assessing the preliminary effects on psychological distress and QOL. DISCUSSION This is the first RCT of a virtual reality-delivered psychosocial intervention for the HSCT population. If deemed feasible, a future larger multi-site clinical trial can evaluate the efficacy of BMT-VR on outcomes for patients hospitalized for HSCT.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Richard Newcomb
- Harvard Medical School, Boston, MA, USA; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Karl A Lorenz
- Division of Primary Care and Population Health, Section of Palliative Care, Palo Alto VA Health Care System, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Riley Psenka
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Katherine Holmbeck
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Emelia J Farnam
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Alexandra Tse
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Lauren P Waldman
- Harvard Medical School, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Areej El-Jawahri
- Harvard Medical School, Boston, MA, USA; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
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El-Jawahri A, Webb JA, Breffni H, Zimmermann C. Integrating Palliative Care and Hematologic Malignancies: Bridging the Gaps for Our Patients and Their Caregivers. Am Soc Clin Oncol Educ Book 2024; 44:e432196. [PMID: 38768404 DOI: 10.1200/edbk_432196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Patients with hematologic malignancies (HMs) struggle with immense physical and psychological symptom burden, which negatively affect their quality of life (QOL) throughout the continuum of illness. These patients are often faced with substantial prognostic uncertainty as they navigate their illness course, which further complicates their medical decision making, especially at the end of life (EOL). Consequently, patients with HM often endure intensive medical care at the EOL, including frequent hospitalization and intensive care unit admissions, and they often die in the hospital. Our EOL health care delivery models are not well suited to meet the unique needs of patients with HMs. Although studies have established the role of specialty palliative care for improving QOL and EOL outcomes in patients with solid tumors, numerous disease-, clinician-, and system-based barriers prevail, limiting the integration of palliative care for patients with HMs. Nonetheless, multiple studies have emerged over the past decade identifying the role of palliative care integration in patients with various HMs, resulting in improvements in patient-reported QOL, symptom burden, and psychological distress, as well as EOL care. Importantly, these studies have also identified active components of specialty palliative care interventions, including strategies to promote adaptive coping especially in the face of prognostic uncertainty. Future work can leverage the knowledge gained from specialty palliative care integration to develop and test primary palliative care interventions by training clinicians caring for patients with HMs to incorporate these strategies into their clinical practice.
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Affiliation(s)
- Areej El-Jawahri
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jason A Webb
- Knight Cancer Institute, Oregon Health and Sciences University, Portland, Oregon
| | - Hannon Breffni
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Patel RV, Ali F, Chiad Z, Chojecki AL, Webb JA, Rosa WE, LeBlanc TW. Top Ten Tips Palliative Care Clinicians Should Know About Acute Myeloid Leukemia. J Palliat Med 2024; 27:794-801. [PMID: 38064538 DOI: 10.1089/jpm.2023.0638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Acute myeloid leukemia (AML) is the most common form of acute leukemia in adults. Rapidly proliferating leukemic cells cause symptoms and increase the risk of infection. While individuals may initially benefit from supportive measures, disease-directed therapy may ultimately be required for symptom management, even at the end of life, although this may also inadvertently increase symptom burden. This unpredictable illness trajectory complicates prognostic uncertainty and the timing of hospice referral, which may prohibit access to palliative therapies and lead to recurrent hospitalizations. However, emerging evidence demonstrates that early palliative care (PC) integration with standard leukemia care results in improved quality of life, psychological outcomes, and greater participation in advance care planning. To orient PC clinicians asked to care for patients with AML, this article highlights 10 salient considerations.
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Affiliation(s)
- Rushil V Patel
- Division of Hematology and Oncology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Fatima Ali
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Zane Chiad
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | | | - Jason A Webb
- Section of Palliative Care, Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Thomas W LeBlanc
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA
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Ames SC, Lange L, Ames GE, Heckman MG, White LJ, Roy V, Foran JM. A prospective study of the relationship between illness perception, depression, anxiety, and quality of life in hematopoietic stem cell transplant patients. Cancer Med 2024; 13:e6906. [PMID: 38205943 PMCID: PMC10905249 DOI: 10.1002/cam4.6906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
AIM The aim of study was to investigate whether depression and anxiety symptoms and illness perception prior to hematopoietic stem cell transplantation (HSCT) predict health related quality of life (HRQOL) at Day 100 and 1 year following HSCT. METHODS A total of 205 patients who underwent HSCT (N = 127 autologous transplants, N = 78 allogeneic transplants) were included in this prospective study. Baseline assessment was assessed prior to transplantation and post HSCT data were collected at Day 100 and 1 year. At baseline we assessed depressive symptoms (Patient Health Questionnaire-9), anxiety symptoms (Generalized Anxiety Disorder-7), illness perception (Brief Illness Perception Questionnaire), and HRQOL (Functional Assessment of Cancer Therapy-BMT). RESULTS Patients who expressed a greater level of concern about the severity, course, and ability to exert control over one's illness (i.e., illness perception) and who reported a greater level of depression and anxiety symptoms prior to HSCT reported lower HRQOL at both Day 100 and 1 year posttransplant, with a similar degree of association observed at the two follow-up time points. CONCLUSIONS Our findings suggest that pretransplant perceptions about their illness and negative mood are significant predictors of HRQOL following HSCT. Illness perception, depression, and anxiety are potentially modifiable risk factors for less than optimal outcome after HCSCT and intervention strategies should be explored.
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Affiliation(s)
- Steven C. Ames
- Division of Hematology and OncologyMayo Clinic FloridaJacksonvilleFloridaUSA
| | - Lori Lange
- Department of PsychologyUniversity of North FloridaJacksonvilleFloridaUSA
| | - Gretchen E. Ames
- Department of Psychiatry and PsychologyMayo Clinic FloridaJacksonvilleFloridaUSA
| | - Michael G. Heckman
- Division of Clinical Trials and BiostatisticsMayo Clinic FloridaJacksonvilleFloridaUSA
| | - Launia J. White
- Division of Clinical Trials and BiostatisticsMayo Clinic FloridaJacksonvilleFloridaUSA
| | - Vivek Roy
- Division of Hematology and OncologyMayo Clinic FloridaJacksonvilleFloridaUSA
| | - James M. Foran
- Division of Hematology and OncologyMayo Clinic FloridaJacksonvilleFloridaUSA
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Hetzer B, Meryk A, Kropshofer G, Salvador C, Riedl D, Lehmann J, Rumpold G, Haid A, Schneeberger-Carta V, Holzner B, Crazzolara R. Integration of Daily Patient-Reported Outcome Measures in Pediatric Stem Cell Transplantation. Transplant Cell Ther 2023; 29:776.e1-776.e7. [PMID: 37741458 DOI: 10.1016/j.jtct.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/31/2023] [Accepted: 09/16/2023] [Indexed: 09/25/2023]
Abstract
Patients' reports of their health status are increasingly used in hematopoietic stem cell transplantation (SCT) to better understand the negative impact on symptom burden and quality of life. Little is known regarding the implementation in routine clinical care, particularly how it can be used to improve supportive care. We sought to the evaluate feasibility of capturing daily patient-reported outcomes (PROs) in the acute phase of SCT to measure physical and psychosocial symptom burden. In this single-center prospective observational study, we assessed daily PRO from conditioning to neutrophil engraftment in children (age 1 to 18 year) who underwent allogeneic or autologous SCT for malignant and nonmalignant disease. The most common acute adverse effects of chemotherapy (pain, nausea, loss of appetite, sleep disturbance, and physical performance impairment) were reported daily via ePROtect, a web-based program designed to integrate health responses. From February 2021 to March 2023, 20 children undergoing allogeneic (allo-) SCT (n = 11) or autologous (auto-) SCT (n = 9) and their proxies consented to participation, all of whom were included in this analysis. A total of 359 PRO questionnaires were completed, corresponding to a median daily completion rate of 72.7% (interquartile range, 60.4% to 83.6%). After conditioning, pain perception anticipated the rise of infectious parameters and the development of mucositis, thus initiating supportive treatment. Patients reported the strongest symptom burden at a median of 8.5 days post-transplantation. At 4 weeks post-transplantation, baseline values were restored for all symptoms. There were no significant differences between auto-SCT and allo-SCT, except for nausea and loss of appetite after administration of antithymocyte globulin in allo-SCT. This study empirically documents the daily health status of children undergoing SCT and proposes an attractive modus operandi on how continuous feedback on health-related symptoms can be integrated into daily clinical practice.
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Affiliation(s)
- Benjamin Hetzer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Meryk
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriele Kropshofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Christina Salvador
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - David Riedl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria; Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Jens Lehmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Rumpold
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexandra Haid
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Roman Crazzolara
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria.
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Caparso C, Ozkan G, Kluge M, Salim H, Khaghany A, Blok A, Choi SW. Mobile Technology to Monitor and Support Health and Well-Being: Qualitative Study of Perspectives and Design Suggestions From Patients Undergoing Hematopoietic Cell Transplantation. JMIR Form Res 2023; 7:e49806. [PMID: 37651172 PMCID: PMC10502589 DOI: 10.2196/49806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/15/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND In the United States, hematopoietic stem cell transplant (HCT) surpasses 22,000 procedures annually. Due to the demanding and time-intensive process of an HCT, patients and family care partners face unique challenges involving their health and well-being. Positive psychology interventions (PPIs) may offer potential solutions to help boost health and well-being. OBJECTIVE This study aimed to explore and understand patients' experiences and perceptions about the use of the Roadmap 2.0 app, specifically its PPI features, during the acute phase of HCT. METHODS From an ongoing randomized controlled trial, HCT patients (n=17) were recruited to participate in semistructured qualitative interviews between October 2022 and January 2023 within a large academic medical center in the Midwestern states. Using a qualitative descriptive approach, interviews were conducted in person or via Zoom. The data were analyzed through constant comparative analysis. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were followed. RESULTS The majority of the participants reported Roadmap 2.0 as easy to use and enjoyed the ability to track their health data (eg, steps, mood, sleep; 9/17). Regarding the use of PPIs during the acute phase of treatment, 88% of the participants reported interest in participating in PPIs, specifically the Pleasant Activity Scheduling (11/17) followed by Gratitude Journaling (7/17) activities. Additionally, participants provided recommendations on adapting Roadmap 2.0. The major recommendations were (1) "Working Together: Need for Dyadic Involvement," (2) "Connectivity with Other Patients," and (3) "Gap in Nutritional Support." Participants (10/17) expressed the importance of caregiver involvement in activities beyond treatment-related management for maintaining healthy patient-caregiver dyadic relationships. They also expressed their desire for connectivity with other patients undergoing HCT, primarily for comparing experiences and discussing topics such as symptom management (8/17). Lastly, participants identified a gap in nutritional support during the HCT process and expressed interest in an intervention that could promote healthy eating through education and notification reminders (9/17). CONCLUSIONS Participants openly expressed their eagerness to participate in research studies that foster connection and positive relationships with their caregivers as well as with other HCT patients. They emphasized the significance of having access to nutritional support or guidance and highlighted the potential benefits of using mobile technology to enhance these collective efforts. TRIAL REGISTRATION ClinicalTrials.gov NCT04094844; https://clinicaltrials.gov/study/NCT04094844. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/19288.
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Affiliation(s)
- Cinzia Caparso
- Department of Systems, Populations and Leadership Center for Improving Patient and Population Health, University of Michigan School of Nursing, Ann Arbor, MI, United States
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
| | - Gwynne Ozkan
- Department of Pediatrics, Blood and Bone Marrow Transplant Program, University of Michigan, Michigan Medicine, Ann Arbor, MI, United States
| | - Maxwell Kluge
- Department of Pediatrics, Blood and Bone Marrow Transplant Program, University of Michigan, Michigan Medicine, Ann Arbor, MI, United States
| | - Humza Salim
- Department of Pediatrics, Blood and Bone Marrow Transplant Program, University of Michigan, Michigan Medicine, Ann Arbor, MI, United States
| | - Aidan Khaghany
- Department of Pediatrics, Blood and Bone Marrow Transplant Program, University of Michigan, Michigan Medicine, Ann Arbor, MI, United States
| | - Amanda Blok
- Department of Systems, Populations and Leadership Center for Improving Patient and Population Health, University of Michigan School of Nursing, Ann Arbor, MI, United States
- Veterans Affairs Center for Clinical Management Research, Ann Arbor Veterans Affairs Health Care System, Ann Arbor, MI, United States
| | - Sung Won Choi
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, United States
- Department of Pediatrics, Blood and Bone Marrow Transplant Program, University of Michigan, Michigan Medicine, Ann Arbor, MI, United States
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7
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Nelson AM, Erdmann AA, Coe CL, Juckett MB, Morris K, Knight JM, Hematti P, Costanzo ES. Inflammatory cytokines and depression symptoms following hematopoietic cell transplantation. Brain Behav Immun 2023; 112:11-17. [PMID: 37236325 PMCID: PMC10524437 DOI: 10.1016/j.bbi.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/21/2023] [Accepted: 05/22/2023] [Indexed: 05/28/2023] Open
Abstract
Increased synthesis and release of inflammatory signalling proteins is common among individuals with hematologic malignancies undergoing hematopoietic cell transplantation (HCT) due to intensive conditioning regimens and complications such as graft-versus-host-disease and infections. Prior research indicates that inflammatory responses can activate central nervous system pathways that evoke changes in mood. This study examined relationships between markers of inflammatory activity and depression symptoms following HCT. Individuals undergoing allogeneic (n = 84) and autologous (n = 155) HCT completed measures of depression symptoms pre-HCT and 1, 3, and 6 months post-HCT. Proinflammatory (IL-6, TNF-α) and regulatory (IL-10) cytokines were assessed by ELISA in peripheral blood plasma. Mixed-effects linear regression models indicated that patients with elevated IL-6 and IL-10 reported more severe depression symptoms at the post-HCT assessments. These findings were replicated when examining both allogeneic and autologous samples. Follow-up analyses clarified that relationships were strongest for neurovegetative, rather than cognitive or affective, symptoms of depression. These findings suggest that anti-inflammatory therapeutics targeting an inflammatory mediator of depression could improve quality of life of HCT recipients.
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Affiliation(s)
- Ashley M Nelson
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - Alexandra A Erdmann
- Department of Pediatrics, Division of Pediatric Cardiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Christopher L Coe
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA
| | - Mark B Juckett
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Keayra Morris
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer M Knight
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Peiman Hematti
- Department of Medicine, Division of Hematology and Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA; Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Erin S Costanzo
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA; Department of Medicine, Division of Hematology and Oncology, School of Medicine and Public Health, University of Wisconsin- Madison, Madison, WI, USA.
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8
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Yanling S, Pu Y, Duorong X, Zhiyong Z, Ting X, Wenjun X, Xiangzhong Z, Jingwen Z. Psychological states and needs among post-allogeneic hematopoietic stem cell transplantation survivors. Cancer Med 2023; 12:16637-16648. [PMID: 37366300 PMCID: PMC10469636 DOI: 10.1002/cam4.6280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
OBJECTIVES To analyze psychological states and needs of patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS Questionnaires were sent to 101 allo-HSCT survivors and 96 questionnaires were returned. The questionnaire covered several categories: (1) demographics and general information, (2) physical conditions, (3) psychologic status and sleep quality, (4) survivor's comments on transplantation, (5) demands and needs, (6) preferred forms and channels of information. RESULTS Depression and poor sleep quality were major concerns troubling allo-HSCT survivors. A notable discrepancy exists between clinically diagnosed depression (4.2%) and self- reported depression based on BDI-13 (55.2%). Young adults (18-49 years old), chronic graft-versus-host disease, the ECOG performance score of 2-4, surviving within 5 years since HSCT, no or low dose of ATG used and being single were significantly associated with self-reported depression. Based on the PSQI score, 75% of survivors experienced varying degrees of sleep quality impairment. Young adults, chronic GVHD and the ECOG score of 2-4 were significantly associated with worse sleep quality. The majority of patients reported unmet needs on physical and psychosocial aspects. Nutrition information was the most important topic, followed by disease treatments and fatigue. Differences in informational needs were found in the survivors according to age, time since HSCT and gender. WeChat public account and WeChat applet, mobile interactive platform and one-to-one conversation were the favorite channel for information. CONCLUSIONS Clinicians should establish more appropriate survivorship care plans focusing on survivors' psychologic states, demands and needs.
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Affiliation(s)
- Sun Yanling
- Department of HematologyThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Yan Pu
- Department of HematologyThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Xu Duorong
- Department of HematologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Zhong Zhiyong
- Department of PsychiatryThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Xu Ting
- Zhongshan School of MedicineSun Yat‐sen UniversityGuangzhouChina
- Zhongshan School of Medicine and Guangdong Province Key Laboratory of Brain Function and DiseaseSun Yat‐sen UniversityGuangzhouChina
| | - Xin Wenjun
- Zhongshan School of MedicineSun Yat‐sen UniversityGuangzhouChina
- Zhongshan School of Medicine and Guangdong Province Key Laboratory of Brain Function and DiseaseSun Yat‐sen UniversityGuangzhouChina
| | - Zhang Xiangzhong
- Department of HematologyThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Zhang Jingwen
- Department of HematologyThe Third Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
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Corman M, Dambrun M, Rubio MT, Cabrespine A, Brindel I, Bay JO, Peffault de La Tour R. The Prospective Effects of Coping Strategies on Mental Health and Resilience at Five Months after HSCT. Healthcare (Basel) 2023; 11:1975. [PMID: 37444809 DOI: 10.3390/healthcare11131975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVES Hematopoietic stem cell transplantation (HSCT) is a stressful event that engenders psychological distress. This study examines the prospective effects of coping strategies during hospitalization on resilience and on various mental-health dimensions at five months after transplantation. METHODS One hundred and seventy patients (Mage = 52.24, SD = 13.25) completed a questionnaire assessing adjustment strategies during hospitalization, and 91 filled out a questionnaire five months after HSCT (Mage = 51.61, SD = 12.93). RESULTS Multiple regression analyses showed that a fighting spirit strategy positively predicted resilience (p < 0.05), whereas anxious preoccupations predicted anxiety (p < 0.05), poorer mental QoL (p < 0.01), and were associated with an increased risk of developing PTSD (OR = 3.27, p < 0.01; 95% CI: 1.36, 7.84) at five months after transplantation. Hopelessness, avoidance, and denial coping strategies were not predictive of any of the mental health outcomes. Finally, the number of transplantations was negatively related to a fighting spirit (p < 0.01) and positively related to hopelessness-helplessness (p < 0.001): Conclusions: These results highlight the importance of developing psychological interventions focused on coping to alleviate the negative psychological consequences of HSCT.
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Affiliation(s)
- Maya Corman
- LAPSCO UMR CNRS 6024, Université Clermont Auvergne (UCA), 34 Avenue Carnot, 63000 Clermont-Ferrand, France
| | - Michael Dambrun
- LAPSCO UMR CNRS 6024, Université Clermont Auvergne (UCA), 34 Avenue Carnot, 63000 Clermont-Ferrand, France
| | - Marie-Thérèse Rubio
- Service D'Hématologie, CHRU Nancy-Hôpitaux de Brabois, 54511 Vandoeuvre-les-Nancy, France
| | - Aurélie Cabrespine
- CHU de Clermont-Ferrand, Site Estaing, Service de Thérapie Cellulaire et D'hématologie Clinique Adulte, 63000 Clermont-Ferrand, France
| | - Isabelle Brindel
- Service D'Hématologie, Hôpital Saint-Louis, Greffe de Moelle, 75010 Paris, France
| | - Jacques-Olivier Bay
- CHU de Clermont-Ferrand, Site Estaing, Service de Thérapie Cellulaire et D'hématologie Clinique Adulte, 63000 Clermont-Ferrand, France
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10
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Di Francesco G, Cieri F, Esposito R, Sciarra P, Ballarini V, Di Ianni M, Santarone S. Fatigue as Mediator Factor in PTSD-Symptoms after Allogeneic Hematopoietic Stem Cell Transplantation. J Clin Med 2023; 12:jcm12082756. [PMID: 37109093 PMCID: PMC10144210 DOI: 10.3390/jcm12082756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/21/2023] [Accepted: 03/30/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) is a valid treatment for hematological oncological or metabolic diseases. Despite its therapeutic efficacy, it is an aggressive treatment that impacts negatively on quality of life (QoL) and may result in Post-Traumatic Stress Disorder (PTSD) symptoms. The aim of this study is to explore rates and risk factors for PTSD symptoms, and fatigue in post-HSCT patients with hematological malignancies. METHODS A total of 123 patients after HSCT were evaluated for PTSD symptoms, QoL and fatigue. PTSD symptoms were assessed with the Impact of Event Scale- Revised (IES-R), QoL was measured with Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) and fatigue symptoms were assessed with Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). RESULTS A total of 58.54% of the sample developed PTSD symptoms after transplant. Patients with PTSD symptoms reported significantly lower QoL total scores and significantly higher fatigue than those without PTSD symptoms (p < 0.001). The SEM analysis showed that worse QoL and fatigue affected PTSD symptomatology along different pathways. Fatigue was found as a major influencing factor of PTSD symptoms directly (β = 0.31 **), while QoL only through the mediation of fatigue at a lesser extent. (β = 0.33 *). CONCLUSIONS Our findings indicate that QoL is a concurrent causative factor to the development of PTSD symptomatology through the mediating role of fatigue. Innovative interventions before transplantation to prevent PTSD symptoms should be investigated to improve survival and QoL in patients.
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Affiliation(s)
- Giulia Di Francesco
- Hematology Unit, Department of Oncology-Hematology, Pescara Hospital, 65100 Pescara, Italy
| | - Filippo Cieri
- Department of Neurology, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV 89106, USA
| | - Roberto Esposito
- Clinica Diagnostica Titano (Bianalisi), 47891 Falciano, San Marino
- Azienda Sanitaria Territoriale (AST1), 61121 Pesaro, Italy
| | - Pierpaola Sciarra
- Hematology Unit, Department of Oncology-Hematology, Pescara Hospital, 65100 Pescara, Italy
| | - Valeria Ballarini
- Hematology Unit, Department of Oncology-Hematology, Pescara Hospital, 65100 Pescara, Italy
| | - Mauro Di Ianni
- Hematology Unit, Department of Oncology-Hematology, Pescara Hospital, 65100 Pescara, Italy
| | - Stella Santarone
- Bone Marrow Transplant Unit, Department of Oncology-Hematology, Pescara Hospital, 65100 Pescara, Italy
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11
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Balitsky AK, D'Souza A, Levine MN. Important questions for the malignant hematologist to consider when designing or evaluating a study with patient-reported outcome measures (PROMs). Eur J Haematol 2022; 109:3-9. [PMID: 35403753 DOI: 10.1111/ejh.13774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 12/01/2022]
Abstract
Patient-reported outcome measures (PROMs), which are measures of symptom burden, health-related quality of life (HRQoL), and therapy effectiveness have become increasingly important in clinical research. They are unique in that they are reported directly from the patient, without clinician interpretation, thereby avoiding clinician bias. With an increased focus on the patient at the center of health care, PROMs have been increasingly incorporated into clinical research, systematic reviews, and clinical guidelines. Despite the recognition of the importance of including PROMs into clinical haematologic cancer research, barriers have prevented their integration into cancer research. This review highlights the value of including PROMs into clinical haematologic cancer research and addresses the methodological challenges in using and evaluating PROMs. We propose important questions for the malignant haematologist to consider when designing or evaluating a study that includes PROMs.
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Affiliation(s)
- Amaris K Balitsky
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada.,Hamilton Health Sciences - Juravinski Hospital Cancer Centre, Hamilton, Ontario, Canada
| | - Anita D'Souza
- Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin, USA.,Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mark N Levine
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada.,Hamilton Health Sciences - Juravinski Hospital Cancer Centre, Hamilton, Ontario, Canada
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12
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Baer LK, Brister L, Mazanec SR. Development and Implementation of an Advanced Practitioner-Led Survivorship Clinic for Patients Status Post Allogeneic Transplant. J Adv Pract Oncol 2022; 12:775-783. [PMID: 35295542 PMCID: PMC8631341 DOI: 10.6004/jadpro.2021.12.8.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Survivor recovery from hematopoietic cell transplantation (HCT) is long term, with significant physical and psychological morbidities that impact quality of life and reentry into personal and social lives. The optimal timing of when and how to deliver comprehensive HCT survivorship care is not well defined. Purpose: The purpose of this study was to design, implement, and evaluate an advanced practitioner (AP)-led pilot survivorship clinic incorporating an individual and group format for patients post HCT at the 1-year transition period. Methods: A survey assessing physical, social, emotional, and spiritual needs and concerns was mailed to a sample of patients who underwent HCT between 2009 and 2014. This phase 1 survey was utilized in the phase 2 design of an AP-led pilot survivorship clinic for patients post allogeneic HCT. A total of 15 patients were approached, out of which 7 enrolled over a 12-month period in the pilot survivorship clinic. Results: The needs assessment survey noted the most prevalent moderate to high concerns were in the emotional domain, with 52% of respondents identifying fear of cancer returning and new cancer developing. The pilot survivorship clinic incorporating a group visit format with multiple sessions was not feasible for both patients and APs within the context of a small- to medium-sized HCT program. Conclusion: The needs assessment survey underscored the importance of addressing all four quality of life domains in cancer survivors. A hybrid survivorship clinic with one comprehensive group visit may be beneficial for HCT survivors at the 1-year transition for small- to medium-sized HCT programs.
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Affiliation(s)
- Linda K Baer
- University Hospitals Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Lauren Brister
- University Hospitals Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Susan R Mazanec
- University Hospitals Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Case Western Reserve University, Cleveland, Ohio
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13
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Karchoud JF, de Kruif AJTCM, Lamers F, van Linde ME, van Dodewaard-de Jong JM, Braamse AMJ, Sprangers MAG, Beekman ATF, Verheul HMW, Dekker J. Clinical judgment of the need for professional mental health care in patients with cancer: a qualitative study among oncologists and nurses. J Cancer Surviv 2021; 17:884-893. [PMID: 34855132 DOI: 10.1007/s11764-021-01151-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE In daily practice, oncologists and nurses frequently need to decide whether or not to refer a patient for professional mental health care. We explored the indicators oncologists and nurses use to judge the need for professional mental health care in patients with cancer. METHODS In a qualitative study, oncologists (n = 8) and nurses (n = 6) were each asked to select patients who were or were not referred for professional mental health care (total n = 75). During a semi-structured interview, they reflected on their decision concerning the possible referral of the patient. Thematic analysis was used to analyze the data. RESULTS Respondents reported using a strategy when judging whether professional mental health care was needed. They allowed patients time to adjust, while monitoring patients' psychological well-being, especially if patients exhibited specific risk factors. Risk and protective factors for emotional problems included personal, social, and disease- and treatment-related factors. Respondents considered referral for professional mental health care when they noted specific indicators of emotional problems. These indicators included lingering or increasing emotions, a disproportionate intensity of emotions, and emotions with a negative impact on a patient's daily life or treatment. CONCLUSIONS This study identified the strategy, risk and protective factors, and the indicators of emotional problems used by oncologists and nurses when judging the need for professional mental health care in patients with cancer. IMPLICATIONS FOR CANCER SURVIVORS Oncologists and nurses can play an important role in the identification of patients in need of professional mental health care.
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Affiliation(s)
- Jeanet F Karchoud
- Department of Psychiatry, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Public Health Research Institute, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Anja J Th C M de Kruif
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Femke Lamers
- Department of Psychiatry, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Public Health Research Institute, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Myra E van Linde
- Department of Medical Oncology, Amsterdam University Medical Centers, Vrije Universiteit, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | - Annemarie M J Braamse
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Public Health Research Institute, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joost Dekker
- Department of Psychiatry, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Public Health Research Institute, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.
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14
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Amonoo HL, Topping CEW, Clay MA, Reynolds MJ, Rice J, Harnedy LE, Longley RM, LeBlanc TW, Greer JA, Chen YB, DeFilipp Z, Lee SJ, Temel JS, El-Jawahri A. Distress in a Pandemic: Association of the Coronavirus Disease-2019 Pandemic with Distress and Quality of Life in Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2021; 27:1015.e1-1015.e7. [PMID: 34536571 PMCID: PMC8442257 DOI: 10.1016/j.jtct.2021.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/30/2021] [Accepted: 09/05/2021] [Indexed: 11/05/2022]
Abstract
The global coronavirus disease 2019 (COVID-19) pandemic has drastically disrupted cancer care, potentially exacerbating patients’ distress levels. Patients undergoing hematopoietic stem cell transplantation (HSCT) may be especially vulnerable to this pandemic stress. However, the associations of the COVID-19 pandemic with distress, fatigue, and quality of life (QoL) are not well understood in this population. In a cross-sectional analysis of data from 205 patients undergoing HSCT enrolled in a supportive care trial, we compared baseline pre-HSCT distress symptoms (depression, anxiety, and posttraumatic stress disorder [PTSD]), fatigue, and QoL between enrollees before (ie, March 2019-January 2020) and during (ie, March 2020-January 2021) the COVID-19 pandemic. We used linear regression models adjusting for sociodemographics and cancer diagnosis to examine the associations between enrollment period and patient-reported outcomes. We used semistructured qualitative interviews in 20 allogeneic HSCT recipients who were ≥3-months post-HSCT to understand the impact of the COVID-19 pandemic on their recovery post-HSCT. One hundred twenty-four participants enrolled before COVID-19, and 81 participants enrolled during the pandemic. The 2 cohorts had similar baseline demographics and disease risk factors. In multivariate regression models, enrollment during COVID-19 was not associated with pre-HSCT symptoms of depression, anxiety, PTSD, fatigue, or QoL impairment. COVID-19-era participants reported themes of negative (eg, increased isolation) and positive (eg, engagement with meaningful activities) implications of the pandemic on HSCT recovery. We found no differences in pre-HSCT distress, fatigue, or QoL in patients undergoing HSCT before or during the COVID-19 pandemic; however, patients in early recovery post-HSCT report both negative and positive implications of the COVID-19 pandemic in their lives.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Carlisle E W Topping
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Madison A Clay
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Matthew J Reynolds
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Julia Rice
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Lauren E Harnedy
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Regina M Longley
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Thomas W LeBlanc
- Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, North Carolina
| | - Joseph A Greer
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Yi-Bin Chen
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Zachariah DeFilipp
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Stephanie J Lee
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Jennifer S Temel
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts
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15
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Nelson AM, Johnson PC, Kavanaugh AR, Jackson VA, Jagielo AD, Fenech AL, Reynolds MJ, Topping C, Yi AM, Horick N, Temel JS, Greer JA, El-Jawahri A. Palliative care for patients undergoing stem cell transplant: intervention components and supportive care measures. Bone Marrow Transplant 2021; 56:1971-1977. [PMID: 33824441 PMCID: PMC9245444 DOI: 10.1038/s41409-021-01281-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/05/2021] [Accepted: 03/24/2021] [Indexed: 11/09/2022]
Abstract
An inpatient palliative care intervention during HCT led to improvement in patient QOL and mood. We sought to describe components of the intervention, investigate differences in supportive care practices by treatment arm, and explore whether these differences mediated the impact of the intervention on patient QOL and mood. We conducted a secondary analysis of a randomized trial investigating inpatient palliative care integrated with transplant care versus standard transplant care for HCT recipients. Palliative care clinicians completed weekly surveys to describe topics addressed during visits. We extracted use of supportive care medications from the medical record. Participants completed QOL and mood assessments at baseline and two weeks post-HCT. Causal mediation assessed whether differences in supportive care practices mediated the impact of the intervention on patient-reported outcomes. A total of 160 HCT recipients participated. Palliative care visits most frequently focused on managing symptoms and coping with HCT. Patients randomized to the intervention were more likely to use Patient-Controlled Analgesia (PCA) (32.1% vs. 15.2%, p = 0.02) and atypical antipsychotics (35.8% vs. 17.7%, p = 0.01). Neither PCA nor atypical antipsychotics mediated the effect of the intervention on patient-reported outcomes. Future work to explore mechanisms by which the palliative care intervention improves QOL and mood is needed.
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Affiliation(s)
- Ashley M Nelson
- Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - P Connor Johnson
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Alison R Kavanaugh
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Vicki A Jackson
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Alisha M Yi
- Massachusetts General Hospital, Boston, MA, USA
| | - Nora Horick
- Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer S Temel
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Joseph A Greer
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Areej El-Jawahri
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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16
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Janicsák H, Ungvari GS, Gazdag G. Psychosocial aspects of hematopoietic stem cell transplantation. World J Transplant 2021; 11:263-276. [PMID: 34316451 PMCID: PMC8290998 DOI: 10.5500/wjt.v11.i7.263] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/18/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) has become a conventional and potentially curative treatment for various hematological diseases. As more sophisticated procedures have been developed and mortality rates have decreased, attention has shifted to the psychosocial challenges associated with transplantation. The psychosocial difficulties accompanying transplantation are addressed in the context of both quality of life (QOL) and psychopathological research. Among the psychiatric comorbidities of HSCT, anxiety, depression, sleep and sexual disorders, delirium and post-traumatic stress disorder are the most studied conditions. Recently, more attention has been focused on the psychosocial burden of caregivers. Devising recommendations for the management of psychiatric symptoms and psychosocial interventions in HSCT sufferers and close relatives is a major concern to consultation–liaison psychiatrists and transplant teams. This review synthesizes and critically evaluates the current literature on the psychosocial aspects of HSCT and appraises the clinical significance of these outcomes. Issues of QOL assessment; psychosocial functioning and QOL in the course of HSCT; impact of graft-versus-host disease and other predictors of QOL and psychosocial functioning; comorbid psychiatric disorders; and interventions to maintain or improve QOL and reduce psychopathology and psychosocial burden on family members are presented.
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Affiliation(s)
- Henrietta Janicsák
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Gabor S Ungvari
- Division of Psychiatry, University of Notre Dame, Fremantle 6009, Australia
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth 6009, Australia
| | - Gábor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
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17
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Ebraheem MS, Seow H, Balitsky AK, Pond GR, Wildes TM, Sivapathasundaram B, Sussman J, Mian H. Trajectory of Symptoms in Patients Undergoing Autologous Stem Cell Transplant for Multiple Myeloma: A Population-Based Cohort Study of Patient-Reported Outcomes. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e714-e721. [PMID: 34099429 DOI: 10.1016/j.clml.2021.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Autologous stem cell transplant (ASCT) is an established treatment for patients with newly diagnosed multiple myeloma (NDMM). Understanding the symptom burden associated with ASCT may be an important consideration for patients with NDMM when selecting treatment options. PATIENTS AND METHODS We conducted a population-based study of patients who underwent an ASCT for NDMM in Ontario, Canada, between 2007 and 2018. The patient-reported outcome, Edmonton Symptom Assessment System (ESAS) score, which captures nine common cancer-associated symptoms and is routinely collected at all outpatient visits, was linked to provincial administrative healthcare data. The monthly prevalence of moderate or severe symptoms (ESAS ≥ 4) each month in the first year following ASCT was analyzed. A multivariable logistic regression model was used to identify factors associated with moderate to severe symptoms. RESULTS In our final cohort of 1969 patients who had undergone an ASCT, a total of 12,820 unique assessments were captured. Symptom burden was highest at 1 month post-ASCT, with moderate to severe tiredness and impaired well-being being the two most common symptoms. Symptom burden substantially improved by 3 months post-ASCT, reaching a new baseline for the year following. On multivariable analysis, female sex, increased co-morbidities, earlier year of diagnosis, and myeloma-related end-organ damage (specifically, bone and kidney disease) were associated with a higher odds of reporting moderate to severe symptoms. CONCLUSION In this large population-based study using patient-reported outcomes, there was a substantial burden of symptoms noted among NDMM patients 1 month post-ASCT, which improved over time. Tailored supportive care interventions should focus on strategies to optimize management of identified symptoms.
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Affiliation(s)
- Mohammed S Ebraheem
- Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON
| | - Hsien Seow
- Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON
| | - Amaris K Balitsky
- Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON
| | - Gregory R Pond
- Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON
| | | | | | - Jonathan Sussman
- Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON
| | - Hira Mian
- Department of Oncology, Juravinski Cancer Center, McMaster University, Hamilton, ON.
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18
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Fenech AL, Van Benschoten O, Jagielo AD, Ufere NN, Topping CEW, Clay M, Jones BT, Traeger L, Temel JS, El-Jawahri A. Post-Traumatic Stress Symptoms in Hematopoietic Stem Cell Transplant Recipients. Transplant Cell Ther 2021; 27:341.e1-341.e6. [PMID: 33836886 PMCID: PMC10636532 DOI: 10.1016/j.jtct.2021.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 02/02/2023]
Abstract
Hematopoietic stem cell transplantation (HCT) is an intensive and potentially curative therapy for patients with hematologic malignancies. Patients admitted for HCT experience a prolonged, isolating hospitalization and endure substantial physical and psychological symptoms. However, there is a paucity of research on the impact of HCT on post-traumatic stress disorder (PTSD) symptoms in transplant recipients. This secondary analysis of 250 patients who underwent autologous and allogeneic HCT examined PTSD using the PTSD Checklist-Civilian measured at 6 months after HCT. We used the Functional Assessment of Cancer Therapy-Bone Marrow Transplant, and the Hospital Anxiety and Depression Scale to assess quality of life (QOL) and depression and anxiety symptoms at the time of admission for HCT, week 2 during hospitalization, and 6 months after HCT. We used multivariate regression models to assess factors associated with PTSD symptoms. Given collinearity between QOL, depression, and anxiety symptoms, we modeled these separately. The rate of clinically significant PTSD symptoms at 6 months after HCT was 18.9% (39/206). Participants with clinically significant PTSD symptoms experienced hypervigilance (92.3%), avoidance (92.3%), and intrusion (76.9%) symptoms. Among patients without clinically significant PTSD symptoms, 24.5% had clinically significant hypervigilance symptoms and 13.7% had clinically significant avoidance symptoms. Lower QOL at time of HCT admission (B = -0.04, P = .004) and being single (B = -3.35, P = .027) were associated with higher PTSD symptoms at 6 months after HCT. Higher anxiety at time of HCT admission (B = 1.34, P <.001), change in anxiety during HCT hospitalization (B = 0.59, P =.006), and being single (B = -3.50, P = .017) were associated with higher PTSD symptoms at 6 months. In a separate model using depression, younger age (B = -0.13, P = .017), being single (B = -3.58, P = .018), and higher baseline depression symptoms were also associated with higher PTSD symptoms at 6 months (B = 0.97, P < .001). Approximately one fifth of patients undergoing HCT experience clinically significant PTSD symptoms at 6 months after transplantation. The prevalence of hypervigilance and avoidance symptoms are notable even among patients who do not have clinically significant PTSD symptoms. Interventions to prevent and treat PTSD symptoms in HCT recipients are clearly warranted.
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Affiliation(s)
- Alyssa L Fenech
- Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
| | - Olivia Van Benschoten
- Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Annemarie D Jagielo
- Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Nneka N Ufere
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Carlisle E W Topping
- Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Madison Clay
- Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Bailey T Jones
- Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Lara Traeger
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jennifer S Temel
- Center for Thoracic Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Areej El-Jawahri
- Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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19
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Khan Z, Agarwal NB, Bhurani D, Khan MA. Risk Factors for Hematopoietic Stem Cell Transplantation-Associated Bone Loss. Transplant Cell Ther 2021; 27:212-221. [PMID: 33045384 DOI: 10.1016/j.bbmt.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/30/2020] [Accepted: 10/04/2020] [Indexed: 11/28/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT), including bone marrow transplantation, is the treatment of choice for many hematologic diseases, including hematologic malignancies and different types of anemia. The use of HSCT is increasing annually, mainly because advanced research that has been conducted in this area has exponentially expanded the indications for HSCT and significantly improved transplantation techniques and supportive care practices. Collectively, these improvements have led to an increase in the overall survival of HSCT patients. However, as post-HSCT survival is increasing, awareness of the potential late complications of HSCT is also growing. Unpredictable bone loss is one of the major post-HSCT complications that can cause significant morbidity and impair the quality of life of survivors. Although the exact mechanism of post-HSCT bone loss is not yet known, previous studies have suggested that numerous factors, including destructive preparative regimens (eg, high-dose chemotherapy, total body irradiation), treatment-related complications (eg, graft-versus-host disease), endocrine abnormalities (eg, diabetes mellitus, thyroid dysfunction, adrenal insufficiency), lack of physical activity, and the underlying disease itself are responsible for HSCT-associated bone loss. Sufficient data have been collected to suggest that post-HSCT bone loss can be prevented and treated using the same preventive and treatment modalities as used for the general population. Various guidelines have been formulated to help keep a check on HSCT recipients' deteriorating bone health.
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Affiliation(s)
- Zehva Khan
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Nidhi B Agarwal
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Dinesh Bhurani
- Department of Hemato-Oncology and Bone Marrow Transplantation, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Mohd Ashif Khan
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India.
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20
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Amonoo HL, Johnson PC, Dhawale TM, Traeger L, Rice J, Lavoie MW, Ufere NN, Longley RM, Harnedy LE, Clay MA, Topping CEW, DeFilipp Z, Chen YBA, El-Jawahri A. Sharing and caring: The impact of social support on quality of life and health outcomes in hematopoietic stem cell transplantation. Cancer 2021; 127:1260-1265. [PMID: 33598938 DOI: 10.1002/cncr.33455] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Social support is crucial for successful recovery after hematopoietic stem cell transplantation (HSCT) and has the potential to affect patient quality of life (QOL) and health outcomes. However, there are limited data on the relationship between a patient's perception of his or her social support and these outcomes. METHODS The authors conducted a secondary analysis of 250 autologous and allogeneic HSCT recipients enrolled in 2 supportive care trials at Massachusetts General Hospital from April 2011 through February 2016. They assessed social support as a patient's perception of his or her social well-being via the social well-being subscale of the Functional Assessment of Cancer Therapy. The authors used multivariate regression analyses to examine the relationship between pretransplant social well-being and QOL (Functional Assessment of Cancer Therapy-Treatment Outcome Index), psychological distress (Hospital Anxiety and Depression Scale), posttraumatic stress disorder [PTSD] symptoms (PTSD Checklist), fatigue (Functional Assessment of Cancer Therapy-Fatigue), and health care utilization (hospitalizations and days alive and out of the hospital) 6 months after HSCT. RESULTS Participants were on average 56.4 years old (SD, 13.3 years); 44% (n = 110) and 56% (n = 140) received autologous and allogeneic HSCT, respectively. Greater pre-HSCT social well-being was associated with higher QOL (B = 0.10; 95% CI, 0.06-0.13; P < .001), lower psychological distress (B = -0.21; 95% CI, -0.29 to -0.12; P < .001), and lower PTSD symptoms (B = -0.12; 95% CI, -0.19 to -0.06; P < .001). Pre-HSCT social well-being was not significantly associated with fatigue or health care utilization 6 months after HSCT. CONCLUSIONS Patients with higher pre-HSCT perceptions of their social support reported better QOL and lower psychological distress 6 months after HSCT. These findings underscore the potential for social support as a modifiable target for future supportive care interventions to improve the QOL and care of HSCT recipients.
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Affiliation(s)
- Hermioni L Amonoo
- Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - P Connor Johnson
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Tejaswini M Dhawale
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Lara Traeger
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Julia Rice
- Massachusetts General Hospital, Boston, Massachusetts
| | | | - Nneka N Ufere
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | - Zachariah DeFilipp
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Yi-Bin A Chen
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
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21
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Brice L, Gilroy N, Dyer G, Kabir M, Greenwood M, Larsen S, Moore J, Gottlieb D, Hertzberg M, Brown L, Hogg M, Huang G, Ward C, Kerridge I. Predictors of quality of life in allogeneic hematopoietic stem cell transplantation survivors. J Psychosoc Oncol 2021; 39:534-552. [PMID: 33468039 DOI: 10.1080/07347332.2020.1870644] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To establish the demographic, medical, transplant, and lifestyle factors that impact Quality of Life (QoL) in long-term survivors of allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT). DESIGN Cross-sectional study utilizing self-report measures. SAMPLE/METHODS In this cross-sectional study of 441 adult survivors of allo-HSCT, participants completed questionnaires assessing QoL, psychological, social, demographic, and clinical variables. FINDINGS Factors associated with improved QoL post-allo-HSCT included time since transplant, female gender, attendance at outpatient appointments, health screening uptake, exercise, and resumption of travel. Factors significantly associated with impaired QoL included chronic morbidities (GVHD), taking psychotropic medication, failure to resume sexual activity (in men), male gender, psychological distress, low income or decline in work status, transition to non-physical work, and necessity for post-allo-HSCT care from various health professionals. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Identification of survivors more likely to experience a reduced QoL following allo-HSCT may enable the targeting of health services to the most vulnerable, and the development of interventions and resources. The data from this study led to the development of HSCT Long-Term Follow Up Clinical Guidelines in New South Wales.
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Affiliation(s)
- Lisa Brice
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Nicole Gilroy
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Gemma Dyer
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia.,Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Sydney, NSW, Australia
| | - Matthew Greenwood
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, NSW, Australia
| | - Stephen Larsen
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - John Moore
- Department of Haematology, St Vincents Hospital, Sydney, NSW, Australia
| | - David Gottlieb
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, NSW, Australia
| | - Louisa Brown
- Department of Haematology, Calvery Mater Hospital, Newcastle, NSW, Australia
| | - Megan Hogg
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Gillian Huang
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Chris Ward
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Ian Kerridge
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
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22
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Corman M, Rubio MT, Cabrespine A, Brindel I, Bay JO, De La Tour RP, Dambrun M. Retrospective and prospective measures of post-traumatic growth reflect different processes: longitudinal evidence of greater decline than growth following a hematopoietic stem-cell transplantation. BMC Psychiatry 2021; 21:27. [PMID: 33430807 PMCID: PMC7798346 DOI: 10.1186/s12888-020-03007-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/08/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This prospective longitudinal study examined and compared two measures (prospective and retrospective ones) of post-traumatic growth (PTG) following Hematopoietic Stem-Cell Transplantation (HSCT) and their respective relationships with mental health and psychological disposition. We also tested the hypothesis that unwillingness to be in contact with distressing thoughts and feelings-i.e. experiential avoidance-would moderate the relationship between Post-Traumatic Stress Disorder (PTSD) and growth. METHODS This study was carried out with 187 patients. Patients completed the Post-Traumatic Growth Inventory (PTGI) 5 months after HSCT and scales tapping into the five domains of PTGI during hospitalisation and 5 months after HSCT. Mental health and psychological disposition were also assessed prior to hospitalisation. A PTSD scale was administered at the five-month follow-up. RESULTS Prospective and retrospective measures of PTG were weakly correlated. Bayesian pre/post-HSCT comparisons in the prospective measure of PTG revealed substantial to very strong decline in four of the five dimensions assessed. Overall, RCI indicated a reliable increase for 5.6% of patients and a reliable decrease for 40.8% of patients. Confirming that retrospective and prospective measures of PTG reflect different processes, they were not related to the same mental health and psychological disposition variables. Moreover, the hypothesis that acquiring positive outcomes from a potentially traumatic experience, such as HSCT, requires direct confrontation with the source of distress was supported in the case of the retrospective measure of growth but not in the case of the prospective measure growth. CONCLUSIONS Retrospective measures such as the PTGI do not appear to assess actual pre- to post-HSCT change. HSCT seems more linked to psychological decline than to growth.
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Affiliation(s)
- Maya Corman
- grid.494717.80000000115480420Université Clermont Auvergne (UCA), LAPSCO CNRS, 34 avenue Carnot, 63037 Clermont-Ferrand, France
| | - Marie-Thérèse Rubio
- grid.410527.50000 0004 1765 1301Service d’hématologie, CHRU Nancy- Hôpitaux de Brabois, 54511 Vandoeuvre-les-Nancy, France
| | - Aurélie Cabrespine
- grid.411163.00000 0004 0639 4151CHU de Clermont-Ferrand, site Estaing, service de thérapie cellulaire et d’hématologie clinique adulte, 63000 Clermont-Ferrand, France
| | - Isabelle Brindel
- grid.413328.f0000 0001 2300 6614Hôpital Saint-Louis, service d’hématologie, greffe de moelle, 75010 Paris, France
| | - Jacques-Olivier Bay
- grid.411163.00000 0004 0639 4151CHU de Clermont-Ferrand, site Estaing, service de thérapie cellulaire et d’hématologie clinique adulte, 63000 Clermont-Ferrand, France
| | - Régis Peffault De La Tour
- grid.413328.f0000 0001 2300 6614Hôpital Saint-Louis, service d’hématologie, greffe de moelle, 75010 Paris, France
| | - Michaël Dambrun
- Université Clermont Auvergne (UCA), LAPSCO CNRS, 34 avenue Carnot, 63037, Clermont-Ferrand, France.
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23
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Dekker J, Karchoud J, Braamse AMJ, Buiting H, Konings IRHM, van Linde ME, Schuurhuizen CSEW, Sprangers MAG, Beekman ATF, Verheul HMW. Clinical management of emotions in patients with cancer: introducing the approach "emotional support and case finding". Transl Behav Med 2020; 10:1399-1405. [PMID: 33200793 PMCID: PMC7796719 DOI: 10.1093/tbm/ibaa115] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The current approach to the management of emotions in patients with cancer is “distress screening and referral for the provision of psychosocial care.” Although this approach may have certain beneficial effects, screening and referral programs have shown a limited effect on patient psychological well-being. We argue that this limited effect is due to a mismatch between patient needs and the provision of care, and that a fundamental reconceptualization of the clinical management of emotions in patients with cancer is needed. We describe the rationale and characteristics of “emotional support and case finding” as the approach to the management of emotions in patients with cancer. The two main principles of the approach are: (1) Emotional support: (a) The treating team, consisting of doctors, nurses, and allied health staff, is responsive to the emotional needs of patients with cancer and provides emotional support. (b) The treating team provides information on external sources of emotional support. (2) Case finding: The treating team identifies patients in need of mental health care by means of case finding, and provides a referral to mental health care as indicated. We present a novel perspective on how to organize the clinical management of emotions in patients with cancer. This is intended to contribute to a fruitful discussion and to inform an innovative research agenda on how to manage emotions in patients with cancer.
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Affiliation(s)
- Joost Dekker
- Department of Psychiatry, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Jeanet Karchoud
- Department of Psychiatry, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Annemarie M J Braamse
- Department of Medical Psychology, Amsterdam University Medical Centers (location AMC), Amsterdam, the Netherlands
| | - Hilde Buiting
- Department of Psychiatry, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Inge R H M Konings
- Department of Medical Oncology, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Myra E van Linde
- Department of Medical Oncology, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | | | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers (location AMC), Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, Radboud UMC, Nijmegen, the Netherlands
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24
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Kroemeke A, Sobczyk-Kruszelnicka M. Daily received support and relational functioning in HCT survivors and their caregivers. Psychooncology 2020; 29:1329-1337. [PMID: 32539169 PMCID: PMC7496138 DOI: 10.1002/pon.5440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/18/2020] [Accepted: 06/06/2020] [Indexed: 01/06/2023]
Abstract
Objectives Numerous authors have expressed their interest in adjustment and social support in the context of cancer. However, none of the previous studies has directly examined the models describing the links between daily social support and adjustment fluctuation, particularly at the relational level. This study aimed to verify the additive and buffering models of daily received support regarding the relational level of patient‐caregiver relationship, that is, the relationship‐related stress and relationship satisfaction following hematopoietic cell transplantation (HCT). Methods Two hundred patient‐caregiver dyads participated in a 28‐day diary study that was started on the first day after post‐HCT discharge. The participants rated the extent of daily relationship‐related stress, relationship satisfaction, and received support every evening during the study. The analyses were based on the actor‐partner interdependence moderation model. Results Daily deviations in received support were directly associated with concurrent and lagged daily deviations in relationship satisfaction, regardless of relationship‐related stress level in both patients and caregivers. In addition, in caregivers, the effect of daily deviations in received support on relationship satisfaction depended on deviations in relationship‐related stress and was significant on the days with higher relationship‐related stress. Conclusions The findings supported both the additive (in patients and caregivers) and the buffering hypotheses (in caregivers) of daily received support in patient‐caregiver dyads during the first month following HCT. The theoretical and practical implications of the findings are further highlighted.
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Affiliation(s)
- Aleksandra Kroemeke
- Department of Psychology in Warsaw, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Małgorzata Sobczyk-Kruszelnicka
- Departament of Bone Marrow Transplantation and Oncohematology, Sklodowska-Curie National Research Institute of Oncology (MSCNRIO) - Gliwice Branch, Gliwice, Poland
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25
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El-Jawahri A, Jacobs JM, Nelson AM, Traeger L, Greer JA, Nicholson S, Waldman LP, Fenech AL, Jagielo AD, D’Alotto J, Horick N, Spitzer T, DeFilipp Z, Chen YBA, Temel JS. Multimodal psychosocial intervention for family caregivers of patients undergoing hematopoietic stem cell transplantation: A randomized clinical trial. Cancer 2020; 126:1758-1765. [PMID: 31899552 PMCID: PMC7103553 DOI: 10.1002/cncr.32680] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/20/2019] [Accepted: 12/03/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Caregivers of patients undergoing hematopoietic stem cell transplantation (HCT) experience an immense caregiving burden before, during, and after HCT. METHODS We conducted an unblinded, randomized trial of a psychosocial intervention (BMT-CARE) for caregivers of patients undergoing autologous and allogeneic HCT at Massachusetts General Hospital. Caregivers were randomly assigned to BMT-CARE or usual care. BMT-CARE was tailored to the HCT trajectory and integrated treatment-related education and self-care with cognitive-behavioral skills to promote coping. Caregivers assigned to BMT-CARE met with a trained interventionist (a psychologist or a social worker) in person, via telephone, or via videoconferencing for 6 sessions starting before HCT and continuing up to day +60 after HCT. The primary endpoint was feasibility, which was defined as at least 60% of eligible caregivers enrolling and completing 50% or more of the intervention sessions. We assesed caregiver quality of life (QOL; Caregiver Oncology Quality of Life Questionnaire), caregiving burden (Caregiver Reaction Assessment), psychological distress (Hospital Anxiety and Depression Scale), self-efficacy (Cancer Self-Efficacy Scale-Transplant), and coping (Measures of Current Status) at baseline and 30 and 60 days after HCT. We used mixed linear effect models to assess the effect of BMT-CARE on outcomes longitudinally. RESULTS We enrolled 72.5% of eligible caregivers (100 of 138), and 80% attended 50% or more of the intervention sessions. Caregivers randomized to BMT-CARE reported improved QOL (B = 6.11; 95% CI, 3.50-8.71; P < .001), reduced caregiving burden (B = -6.02; 95% CI, -8.49 to -3.55; P < .001), lower anxiety (B = -2.18; 95% CI, -3.07 to -1.28; P < .001) and depression symptoms (B = -1.23; 95% CI, -1.92 to -0.54; P < .001), and improved self-efficacy (B = 7.22; 95% CI, 2.40-12.03; P = .003) and coping skills (B = 4.83; 95% CI, 3.04-6.94; P < .001) in comparison with the usual-care group. CONCLUSIONS A brief multimodal psychosocial intervention tailored for caregivers of HCT recipients is feasible and may improve QOL, mood, coping, and self-efficacy while reducing the caregiving burden during the acute HCT period.
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Affiliation(s)
- Areej El-Jawahri
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Jamie M. Jacobs
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Ashley M. Nelson
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Lara Traeger
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Joseph A. Greer
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Showly Nicholson
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Lauren P. Waldman
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Alyssa L. Fenech
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Annemarie D. Jagielo
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Jennifer D’Alotto
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Nora Horick
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Thomas Spitzer
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Zachariah DeFilipp
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Yi-Bin A. Chen
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
| | - Jennifer S. Temel
- Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts, 02134
- Harvard Medical School, Boston, Massachusetts, 02114
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26
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El-Jawahri A, Nelson AM, Gray TF, Lee SJ, LeBlanc TW. Palliative and End-of-Life Care for Patients With Hematologic Malignancies. J Clin Oncol 2020; 38:944-953. [PMID: 32023164 PMCID: PMC8462532 DOI: 10.1200/jco.18.02386] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2019] [Indexed: 12/18/2022] Open
Abstract
Hematologic malignancies are a heterogeneous group of diseases with unique illness trajectories, treatment paradigms, and potential for curability, which affect patients' palliative and end-of-life care needs. Patients with hematologic malignancies endure immense physical and psychological symptoms because of both their illness and often intensive treatments that result in significant toxicities and adverse effects. Compared with patients with solid tumors, those with hematologic malignancies also experience high rates of hospitalizations, intensive care unit admissions, and in-hospital deaths and low rates of referral to hospice as well as shorter hospice length of stay. In addition, patients with hematologic malignancies harbor substantial misperceptions about treatment risks and benefits and frequently overestimate their prognosis. Even survivors of hematologic malignancies struggle with late effects, post-treatment complications, and post-traumatic stress symptoms that can significantly diminish their quality of life. Despite these substantial unmet needs, specialty palliative care services are infrequently consulted for the care of patients with hematologic malignancies. Several illness-specific, cultural, and system-based barriers to palliative care integration and optimal end-of-life care exist in this population. However, recent evidence has demonstrated the feasibility, acceptability, and efficacy of integrating palliative care to improve the quality of life and care of patients with hematologic malignancies and their caregivers. More research is needed to develop and test population-specific palliative and supportive care interventions to ensure generalizability and to define a sustainable clinical delivery model. Future work also should focus on identifying moderators and mediators of the effect of integrated palliative care models on patient-reported outcomes and on developing less resource-intensive integrated care models to address the diverse needs of this population.
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Affiliation(s)
- Areej El-Jawahri
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Ashley M. Nelson
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Tamryn F. Gray
- Harvard Medical School, Boston, MA
- Dana-Farber Cancer Institute, Boston, MA
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27
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Di Giuseppe G, Thacker N, Schechter T, Pole JD. Anxiety, depression, and mental health-related quality of life in survivors of pediatric allogeneic hematopoietic stem cell transplantation: a systematic review. Bone Marrow Transplant 2020; 55:1240-1254. [DOI: 10.1038/s41409-020-0782-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/24/2019] [Accepted: 01/03/2020] [Indexed: 12/20/2022]
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28
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Lemieux C, Ahmad I, Bambace NM, Bernard L, Cohen S, Delisle JS, Fleury I, Kiss T, Mollica L, Roy DC, Sauvageau G, Roy J, Lachance S. Evaluation of the Impact of Autologous Hematopoietic Stem Cell Transplantation on the Quality of Life of Older Patients with Lymphoma. Biol Blood Marrow Transplant 2019; 26:157-161. [PMID: 31521818 DOI: 10.1016/j.bbmt.2019.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 02/05/2023]
Abstract
High-dose chemotherapy (HDT) followed by autologous hematopoietic stem cell transplantation (AHSCT) improves survival in patients with chemosensitive non-Hodgkin lymphoma (NHL). Determination of the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) has contributed to improve patient selection while allowing for prediction of nonrelapse mortality. We previously demonstrated the efficacy and safety of AHSCT in a cohort of older patients with chemosensitive NHL. Quality of life following AHSCT still has not been widely evaluated. The goal of this study was to assess the long-term quality of life of elderly patients surviving AHSCT. This single-center, Research and Ethics Committee-approved study investigated QoL in survivors of AHSCT for the treatment of NHL in a cohort of older patients. Inclusion criteria were defined as patients age ≥60 years who underwent AHSCT for NHL between January 1, 2008, and January 1, 2015, at our center. Fifty-nine patients from the original cohort of 90 survived at a median of 50 months post-AHSCT. Forty-seven (79.7%) of those patients agreed to complete the QoL assessment questionnaires after the transplantation and are included in this report. All patients provided signed informed consent. We used the EQ-5D instrument to assess mobility, self-care, usual activities, pain/discomfort, and anxiety/depression and the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) questionnaire to assess physical, social/family, emotional, and functional well-being and BMT-specific concerns. With both tools, a higher score indicates better QoL. Fifteen percent of patients were in relapse at the time of the QoL assessment. In the EQ-5D, few patients (9%) reported severe impairment, which requires significant negative effects in 4 or 5 domains. Lower Karnofsky Performance Status (KPS) score at the time of transplantation was negatively correlated with mobility (P= .001), self-care (P= .001), and usual activities (P= .007) dysfunction. Anxiety was significant for patients in relapsed after transplantation (P= .002). FACT-BMT questionnaire results demonstrated that physical, social, and emotional well-being were all well preserved after the transplantation, whereas functional well-being was more variable among patients. Relapse was associated with impaired functional well-being (P= .007) and lower total FACT-BMT score (P= .014). Other comparators, including the conditioning regimen, sex, age subgroups (<65 or ≥65 years), HCT-CI score, and disease status at transplantation, did not impact any of these outcomes. This study demonstrates that physical, social, and functional well-being are preserved in older patients following AHSCT. Low KPS score before AHSCT is a predictor of disability at distance from AHSCT. Relapse following AHSCT remains the most significant impediment to maintaining a good QoL. Innovative interventions to improve performance status before transplantation and measures to prevent relapse thereafter should be investigated to improve survival and QoL.
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Affiliation(s)
- Christopher Lemieux
- Division of Hematology and Medical Oncology, Hematopoietic Cell Transplant Program, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Imran Ahmad
- Division of Hematology and Medical Oncology, Hematopoietic Cell Transplant Program, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Nadia M Bambace
- Division of Hematology and Medical Oncology, Hematopoietic Cell Transplant Program, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Léa Bernard
- Division of Hematology and Medical Oncology, Hematopoietic Cell Transplant Program, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Sandra Cohen
- Division of Hematology and Medical Oncology, Hematopoietic Cell Transplant Program, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Sébastien Delisle
- Division of Hematology and Medical Oncology, Hematopoietic Cell Transplant Program, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Isabelle Fleury
- Division of Hematology and Medical Oncology, Hematopoietic Cell Transplant Program, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Thomas Kiss
- Division of Hematology and Medical Oncology, Hematopoietic Cell Transplant Program, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Luigina Mollica
- Division of Hematology and Medical Oncology, Hematopoietic Cell Transplant Program, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Denis-Claude Roy
- Division of Hematology and Medical Oncology, Hematopoietic Cell Transplant Program, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Guy Sauvageau
- Division of Hematology and Medical Oncology, Hematopoietic Cell Transplant Program, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Jean Roy
- Division of Hematology and Medical Oncology, Hematopoietic Cell Transplant Program, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Silvy Lachance
- Division of Hematology and Medical Oncology, Hematopoietic Cell Transplant Program, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
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Effects of Social Support Source and Effectiveness on Stress Buffering After Stem Cell Transplant. Int J Behav Med 2019; 26:391-400. [PMID: 31140146 DOI: 10.1007/s12529-019-09787-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND This study used the social support effectiveness framework to examine whether effective social support buffered the relationship between stressful life events and distress among hematopoietic stem cell transplant (HSCT) survivors and whether that buffering effect depended on the type of caregiver who provided it (partner versus non-partner caregivers). METHODS A total of 275 HSCT survivors completed measures of the effectiveness of their caregiver's support-social support effectiveness (SSE)-distress, and stressful life events. Hierarchical linear regression was used to analyze a three-way interaction between stressful life events, caregiver SSE, and caregiver type on distress. RESULTS After controlling for covariates, the three-way interaction of stressful life events, caregiver SSE, and caregiver type was significant (b = - 0.21, SE = 0.00, p < 0.001). Among partnered survivors, more stressful life events were associated with greater distress (B = 0.03, SE = 0.01, p = 0.045) when caregiver SSE was low. There was no association between stressful life events and distress when caregiver SSE was average (B = 0.01, SE = 0.01, p = 0.50) or high (B = - 0.01, SE = 0.02, p = 0.61). Among non-partnered survivors, there was a positive association between stressful life events and distress regardless of caregiver SSE. CONCLUSIONS Average or highly effective caregiver support buffered effects of stressful life events on distress among partnered survivors. There was no evidence that support at any level of effectiveness buffered stressful life events among non-partnered survivors. Findings highlight the importance of measuring social support effectiveness and source of support among HSCT survivors.
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Ahmedzai SH, Snowden JA, Ashcroft AJ, Cairns DA, Williams C, Hockaday A, Cavenagh JD, Ademokun D, Tholouli E, Allotey D, Dhanapal V, Jenner M, Yong K, Cavet J, Hunter H, Bird JM, Pratt G, Parrish C, Brown JM, Morris TCM, Cook G. Patient-Reported Outcome Results From the Open-Label, Randomized Phase III Myeloma X Trial Evaluating Salvage Autologous Stem-Cell Transplantation in Relapsed Multiple Myeloma. J Clin Oncol 2019; 37:1617-1628. [PMID: 30969846 PMCID: PMC6858007 DOI: 10.1200/jco.18.01006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Salvage autologous stem-cell transplantation (sASCT) in patients with multiple myeloma (MM) relapsing after a prior autologous stem-cell transplantation leads to increased remission duration and overall survival. We report a comprehensive study on patient-reported outcomes, including quality of life (QoL) and pain in sASCT. METHODS Patients were randomly assigned to either sASCT or nontransplantation consolidation (NTC). Pain and QoL were assessed as secondary outcomes using validated QoL instruments (European Organisation for Research and Treatment of Cancer QLQ-C30 and myeloma-specific module, QLQ-MY20; the Brief Pain Inventory [Short Form]; and the Leeds Assessment of Neuropathic Symptoms and Signs [Self-Assessment] scale). RESULTS A total of 288 patients (> 96%) consented to the QoL substudy. The median follow-up was 52 months. The European Organisation for Research and Treatment of Cancer QLQ-C30 Global health status scores were higher (better) in the NTC group at 100 days after random assignment (P = .0496), but not at later time points. Pain interference was higher (worse) in the sASCT group than in the NTC group at 6 months after random assignment (P = .0267), with patients with sASCT reporting higher scores for Pain interference with daily living for up to 2 years after random assignment. Patients reporting lower concerns about adverse effects of treatment after sASCT had a time to progression advantage. CONCLUSION Patients with sASCT with relapsed MM demonstrated a comparative reduction in QoL and greater impact of treatment adverse effects lasting for 6 months and up to 2 years for pain, after which patients who had received sASCT reported better outcomes. Patients who experienced lower adverse effects after sASCT had longer time to progression and overall survival, showing the need to improve symptom management peritransplantation. To our knowledge, this study provides the most comprehensive picture of QoL before and after sASCT in patients with relapsed MM.
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Affiliation(s)
- Sam H Ahmedzai
- 1 The University of Sheffield, Sheffield, United Kingdom
| | - John A Snowden
- 2 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | | | - Cathy Williams
- 5 Nottingham City Hospitals, Nottingham City, United Kingdom
| | | | - Jamie D Cavenagh
- 6 Barts Health NHS Trust and The London NHS Trust, London, United Kingdom
| | - Debo Ademokun
- 7 Ipswich Hospital NHS Trust, Ipswich, United Kingdom
| | - Eleni Tholouli
- 8 Manchester Royal Infirmary, Manchester, United Kingdom
| | | | | | - Matthew Jenner
- 11 University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Kwee Yong
- 12 University College Hospital, London, United Kingdom
| | - Jim Cavet
- 13 The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Hannah Hunter
- 14 Plymouth Hospitals Trust, Plymouth, United Kingdom
| | - Jennifer M Bird
- 15 University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Guy Pratt
- 16 University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | | | - Gordon Cook
- 4 University of Leeds, Leeds, United Kingdom
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Caregiver availability and patient access to hematopoietic cell transplantation: social worker perspectives inform practice. Support Care Cancer 2019; 27:4253-4264. [DOI: 10.1007/s00520-019-04696-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/08/2019] [Indexed: 01/09/2023]
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Chakraborty R, Sidana S, Shah GL, Scordo M, Hamilton BK, Majhail NS. Patient-Reported Outcomes with Chimeric Antigen Receptor T Cell Therapy: Challenges and Opportunities. Biol Blood Marrow Transplant 2018; 25:e155-e162. [PMID: 30500439 DOI: 10.1016/j.bbmt.2018.11.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/21/2018] [Indexed: 12/16/2022]
Abstract
Patient-reported outcomes (PROs) are an important tool to assess the impact of a new therapy on symptom burden and health-related quality of life (HRQoL). Chimeric antigen receptor T (CAR-T) cell therapies have been approved for use in relapsed or refractory leukemia and lymphoma based on promising efficacy in clinical trials. However, data are lacking on patient-reported toxicity and impact on HRQoL. This review provides an overview of the incorporation of PROs in CAR-T cell therapy and the specific challenges in this context. The first step is to demonstrate feasibility of PRO monitoring in the acute phase after CAR-T cell infusion. Apart from core PRO domains like physical functioning, disease-related symptoms, and symptomatic adverse effects, important measures to consider are cognitive functioning and financial toxicity. Because there are no validated PRO instruments in the setting of CAR-T cell therapy, universally validated measures like Patient-Reported Outcomes Measurement Information System (PROMIS) could be considered, which is also recommended in the setting of hematopoietic stem cell transplantation. Given the timeline of toxicities with CAR-T cell therapy, PRO instruments should be administered at baseline and at least weekly in the first 30 days. Subsequently, frequent monitoring of PROs in the first year might be helpful in identifying short- and intermediate-term toxicities, functional limitations, and neuropsychiatric effects. The major potential challenge in acute phase would be missing data when patients develop severe cytokine release syndrome or neurotoxicity. Designing a strategy for handling missing data is crucial. The long-term safety of CAR-T cell therapy is not well characterized because of short follow-up in most studies reported thus far. PROs should be measured at least yearly after the first year to identify potential late effects like cognitive deficit or autoimmune manifestations. Collaboration between institutions performing cellular therapy and engagement with patients, clinicians, and statisticians with expertise in PROs are crucial for setting a comprehensive agenda on integration of PROs with CAR-T cell therapy.
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Affiliation(s)
| | - Surbhi Sidana
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
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Valdimarsdottir HB, Figueiro MG, Holden W, Lutgendorf S, Wu LM, Ancoli‐Israel S, Chen J, Hoffman‐Peterson A, Granski J, Prescott N, Vega A, Stern N, Winkel G, Redd WH. Programmed environmental illumination during autologous stem cell transplantation hospitalization for the treatment of multiple myeloma reduces severity of depression: A preliminary randomized controlled trial. Cancer Med 2018; 7:4345-4353. [PMID: 30099857 PMCID: PMC6144249 DOI: 10.1002/cam4.1690] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 05/31/2018] [Accepted: 06/16/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Over a third of multiple myeloma (MM) patients report clinical levels of depression during autologous stem cell transplant (ASCT) hospitalization. We report preliminary results from a randomized clinical trial investigating the effect of Programmed Environmental Illumination (PEI) of hospital rooms on depression. METHODS Patients (N = 187) scheduled to receive an ASCT were assessed for eligibility. Those who met study eligibility criteria (n = 44) were randomly assigned to one of two PEI conditions involving delivery of either circadian active bright white light (BWL) or circadian inactive dim white light (DWL) throughout the room from 7 to 10 am daily during hospitalization. Patients completed the Center for Epidemiological Studies Depression Scale (CES-D) prior to hospitalization, at days 2 and 7 post-transplant, and on the third day of engraftment. RESULTS General linear model analyses revealed no difference between the groups in CES-D total score at baseline (P = 0.7859). A longitudinal linear mixed model analysis revealed a significant interaction between time of assessment and light condition [F(3,107) = 2.90; P = 0.0386; ɳ2 = 0.08)], indicating that PEI prevented the development of depression during hospitalization, with effects reaching significance by the third day of engraftment. At the third day of engraftment, 68.4% of the participants in the DWL comparison condition met the criteria for clinically significant depression compared to 42.1% in the BWL condition. CONCLUSION These findings demonstrate that PEI using BWL during MM ASCT hospitalization is effective in reducing the development of depression. Future studies should examine the mechanisms whereby PEI improves depression.
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Affiliation(s)
- Heiðdís B. Valdimarsdottir
- PsychologyReykjavik UniversityReykjavikIceland
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
| | | | - William Holden
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
| | - Susan Lutgendorf
- Departments of Psychology and Brain Sciences, Obstetrics and Gynecology, and UrologyUniversity of Iowa College of Liberal Arts and SciencesIowa CityIowa
| | - Lisa M. Wu
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinois
| | - Sonia Ancoli‐Israel
- Department of PsychiatryUniversity of California San DiegoLa JollaCalifornia
| | - Jason Chen
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
| | - Ariella Hoffman‐Peterson
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
| | - Julia Granski
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
| | - Nina Prescott
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
| | - Alejandro Vega
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
| | - Natalie Stern
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
| | - Gary Winkel
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
| | - William H. Redd
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
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Abstract
OBJECTIVE To describe palliative care integration into oncology, including several models that facilitate this integration, important considerations when initiating a program, special oncologic populations that would benefit from palliative care, and challenges to consider. DATA SOURCES Palliative care and oncology literature over the past decade. CONCLUSION Multiple models exist to facilitate the integration of palliative care based on the needs of the providers or payers. There are several special populations that would benefit from early integration of palliative care. IMPLICATIONS FOR NURSING PRACTICE Nurses play a critical role in identifying patients, providing early primary palliative care, and facilitating collaborative relationships with and referring to specialist palliative care.
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35
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Temporal trajectory of quality of life and its predictors in recipients of hematopoietic stem cell transplantation. Ann Hematol 2018; 97:1407-1415. [DOI: 10.1007/s00277-018-3319-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/23/2018] [Indexed: 01/21/2023]
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36
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El-Jawahri A, Fishman SR, Vanderklish J, Dizon DS, Pensak N, Traeger L, Greer JA, Park ER, Markovitz N, Waldman L, Hunnewell C, Saylor M, Driscoll J, Li Z, Spitzer TR, McAfee S, Chen YB, Temel JS. Pilot study of a multimodal intervention to enhance sexual function in survivors of hematopoietic stem cell transplantation. Cancer 2018. [PMID: 29537491 DOI: 10.1002/cncr.31333] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Although sexual dysfunction is common after hematopoietic stem cell transplantation (HCT), interventions to address sexual function are lacking. METHODS We conducted a pilot study to assess the feasibility and preliminary efficacy of a multimodal intervention to address sexual dysfunction in allogeneic HCT survivors. Transplant clinicians screened HCT survivors ≥3 months post-HCT for sexual dysfunction causing distress. Those who screened positive attended monthly visits with a trained transplant clinician who: 1) performed an assessment of the causes of sexual dysfunction; 2) educated and empowered the patient to address his or her sexual concerns; and 3) implemented therapeutic interventions targeting the patient's needs. Feasibility was defined as having approximately 75% of patients who screened positive agreeing to participate and 80% attending at least 2 intervention visits. We administered the Patient-Reported Outcomes Measurement Information System (PROMIS) sexual function and satisfaction measure, the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), and the Hospital Anxiety and Depression Scale (HADS) to evaluate sexual function, quality of life (QOL), and mood, respectively, at baseline and 6 months postintervention. RESULTS Approximately 33.1% of patients (50 of 151 patients) screened positive for sexual dysfunction causing distress and 94.0% (47 of 50 patients) agreed to participate, with 100% attending 2 intervention visits. Participants reported improvements in satisfaction (P<.0001) and interest in sex (P<.0001), as well as orgasm (P<.0001), erectile function (P<.0001), vaginal lubrication (P = .0001), and vaginal discomfort (P = .0005). At baseline, approximately 32.6% of participants were not sexually active, compared with 6.5% after the intervention (P = .0005). Participants reported improvement in their QOL (P<.0001), depression (P = .0002), and anxiety (P = .0019). CONCLUSIONS A multimodal intervention to address sexual dysfunction integrated within the transplant clinic is feasible with encouraging preliminary efficacy for improving sexual function, QOL, and mood in HCT survivors. Cancer 2018;124:2438-46. © 2018 American Cancer Society.
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Affiliation(s)
- Areej El-Jawahri
- Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sarah R Fishman
- Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Julie Vanderklish
- Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Don S Dizon
- Department of Medical Oncology, Lifespan Cancer Institute, Rhode Island Hospital, Providence, Rhode Island.,Warren Alpert Medical School of Brown University, Brown University, Providence, Rhode Island
| | - Nicole Pensak
- Department of Clinical Psychology, Georgetown University Medical Center, Washington, DC
| | - Lara Traeger
- Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Joseph A Greer
- Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Elyse R Park
- Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Netana Markovitz
- Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Lauren Waldman
- Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Chrisa Hunnewell
- Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Meredith Saylor
- Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jessica Driscoll
- Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Zhigang Li
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, New Hampshire
| | - Thomas R Spitzer
- Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Steven McAfee
- Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Yi-Bin Chen
- Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jennifer S Temel
- Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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37
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Rini C, Symes Y, Campo RA, Wu LM, Austin J. I Keep my Problems to Myself: Negative Social Network Orientation, Social Resources, and Health-Related Quality of Life in Cancer Survivors. Ann Behav Med 2017; 50:385-96. [PMID: 26693932 DOI: 10.1007/s12160-015-9765-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cancer survivors treated with hematopoietic stem cell transplant rely on their social network for successful recovery. However, some survivors have negative attitudes about using social resources (negative social network orientation) that are critical for their recovery. PURPOSE We examined the association between survivors' social network orientation and health-related quality of life (HRQoL) and whether it was mediated by social resources (network size, perceived support, and negative and positive support-related social exchanges). METHODS In a longitudinal study, 255 survivors completed validated measures of social network orientation, HRQoL, and social resources. Hypotheses were tested using path analysis. RESULTS More negative social network orientation predicted worse HRQoL (p < .001). This association was partially mediated by lower perceived support and more negative social exchanges. CONCLUSIONS Survivors with negative social network orientation may have poorer HRQoL in part due to deficits in several key social resources. Findings highlight a subgroup at risk for poor transplant outcomes and can guide intervention development.
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Affiliation(s)
- Christine Rini
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, Campus box 7440, 319C Rosenau Hall, Chapel Hill, NC, 27599-7440, USA.
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
| | - Yael Symes
- Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, Campus box 7440, 319C Rosenau Hall, Chapel Hill, NC, 27599-7440, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Rebecca A Campo
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa M Wu
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Jane Austin
- Department of Psychology, William Paterson University, Wayne, NJ, USA
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38
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El-Jawahri A, Traeger L, Greer JA, VanDusen H, Fishman SR, LeBlanc TW, Pirl WF, Jackson VA, Telles J, Rhodes A, Li Z, Spitzer TR, McAfee S, Chen YBA, Temel JS. Effect of Inpatient Palliative Care During Hematopoietic Stem-Cell Transplant on Psychological Distress 6 Months After Transplant: Results of a Randomized Clinical Trial. J Clin Oncol 2017; 35:3714-3721. [PMID: 28926288 DOI: 10.1200/jco.2017.73.2800] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose Inpatient palliative care integrated with transplant care improves patients' quality of life (QOL) and symptom burden during hematopoietic stem-cell transplant (HCT). We assessed patients' mood, post-traumatic stress disorder (PTSD) symptoms, and QOL 6 months post-transplant. Methods We randomly assigned 160 patients with hematologic malignancies who underwent autologous or allogeneic HCT to inpatient palliative care integrated with transplant care (n = 81) or transplant care alone (n = 79). At baseline and 6 months post-transplant, we assessed mood, PTSD symptoms, and QOL with the Hospital Anxiety and Depression Scale and Patient Health Questionnaire, PTSD checklist, and Functional Assessment of Cancer Therapy-Bone Marrow Transplant. To assess symptom burden during HCT, we used the Edmonton Symptom Assessment Scale. We used analysis of covariance while controlling for baseline values to examine intervention effects and conducted causal mediation analyses to examine whether symptom burden or mood during HCT mediated the effect of the intervention on 6-month outcomes. Results We enrolled 160 (86%) of 186 potentially eligible patients between August 2014 and January 2016. At 6 months post-transplant, intervention participants reported lower depression symptoms on the Hospital Anxiety and Depression Scale and Patient Health Questionnaire (adjusted mean difference, -1.21 [95% CI, -2.26 to -0.16; P = .024] and -1.63 [95% CI, -3.08 to -0.19; P = .027], respectively) and lower PTSD symptoms (adjusted mean difference, -4.02; 95% CI, -7.18 to -0.86; P = .013), but no difference in QOL or anxiety. Symptom burden and anxiety during HCT hospitalization partially mediated the effect of the intervention on depression and PTSD at 6 months post-transplant. Conclusion Inpatient palliative care integrated with transplant care leads to improvements in depression and PTSD symptoms at 6 months post-transplant. Reduction in symptom burden and anxiety during HCT partially accounts for the effect of the intervention on these outcomes.
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Affiliation(s)
- Areej El-Jawahri
- Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Lara Traeger
- Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Joseph A Greer
- Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Harry VanDusen
- Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Sarah R Fishman
- Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Thomas W LeBlanc
- Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - William F Pirl
- Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Vicki A Jackson
- Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Jason Telles
- Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Alison Rhodes
- Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Zhigang Li
- Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Thomas R Spitzer
- Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Steven McAfee
- Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Yi-Bin A Chen
- Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Jennifer S Temel
- Areej El-Jawahri, Lara Traeger, Joseph A. Greer, Harry VanDusen, Sarah R. Fishman, William F. Pirl, Vicki A. Jackson, Jason Telles, Alison Rhodes, Thomas R. Spitzer, Steven McAfee, Yi-Bin A. Chen, and Jennifer S. Temel, Massachusetts General Hospital; Harvard Medical School, Boston MA; Thomas W. LeBlanc, Duke University School of Medicine, Durham NC; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH
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Kroemeke A, Sobczyk-Kruszelnicka M, Kwissa-Gajewska Z. Everyday life following hematopoietic stem cell transplantation: decline in physical symptoms within the first month and change-related predictors. Qual Life Res 2017; 27:125-135. [PMID: 28900828 PMCID: PMC5770502 DOI: 10.1007/s11136-017-1705-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE Lower quality of life, especially in the physical domain (Physical-QOL), is common in patients after hematopoietic stem cell transplantation (HSCT). However, few studies explore changes in the Physical-QOL, i.e., physical symptoms, in everyday life of patients following HSCT. The present study addresses this gap by examining patient daily physical symptoms and their predictors in terms of demographic and clinical characteristics. METHODS Physical symptoms were reported by 188 patients (56.9% men; aged 47.6 ± 13.4 years) for 28 consecutive days after post-HSCT hospital discharge. Multilevel modeling was used to investigate fixed and random effects for physical symptom changes over time. RESULTS The results indicated that the initial level of physical symptoms (immediately after hospital discharge) systematically decreased over 28 days. Treatment toxicity (WHO scale; β = 0.09, p < .01) and baseline depressive symptoms (CES-D scale; β = 0.06, p < .01) were associated with the initial level of physical symptoms. Patients with more depressive symptoms before HSCT and with more adverse treatment effects presented with more physical symptoms immediately after hospital discharge. The type of transplant, diagnosis, and conditioning regimen differentiated the course of physical symptoms. Patients with leukemias and other myeloid neoplasms (β = 0.05, p < .01), after allogeneic HSCT (β = -0.06, p < .01), and with non-myeloablative conditioning (β = -0.09, p < .01) showed a significant lower decrease in symptoms over time. Patients with multiple myeloma presented with the most rapid improvement (β = -.03, p < .05). CONCLUSIONS The findings suggest a heterogeneous and rather positive response to HSCT. Treatment-related conditions occurred to be a significant predictor of the intensity of change in physical functioning after HSCT.
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Affiliation(s)
- Aleksandra Kroemeke
- Department of Psychology, SWPS University of Social Sciences and Humanities, Chodakowska Street 19/31, 03-815, Warsaw, Poland.
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Shaw BE, Brazauskas R, Millard HR, Fonstad R, Flynn KE, Abernethy A, Vogel J, Petroske C, Mattila D, Drexler R, Lee SJ, Horowitz MM, Rizzo JD. Centralized patient-reported outcome data collection in transplantation is feasible and clinically meaningful. Cancer 2017; 123:4687-4700. [PMID: 28817182 DOI: 10.1002/cncr.30936] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/23/2017] [Accepted: 07/05/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Allogeneic hematopoietic cell transplantation (HCT) cures many patients, but often with the risk of late effects and impaired quality of life. The value of quantifying patient-reported outcomes (PROs) is increasingly being recognized, but the routine collection of PROs is uncommon. This study evaluated the feasibility of prospective PRO collection by an outcome registry at multiple time points from unselected HCT patients undergoing transplantation at centers contributing clinical data to the Center for International Blood and Marrow Transplant Research (CIBMTR), and then it correlated the PRO data with clinical and demographic data. METHODS The Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), 36-Item Short Form Health Survey (SF-36), and Pediatric Quality of Life Inventory measures were administered before HCT, on day 100, and at 6 and 12 months. Patients were recruited by the transplant center, but posttransplant PRO collection was managed centrally by the CIBMTR. RESULTS There were 580 eligible patients, and 390 (67%) enrolled. Feasibility was shown by high time-specific retention rates (176 of 238 at 1 year or 74%) and participant satisfaction. Factors associated with higher response rates were an age > 50 years (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.03-2.41; P = .0355), white race (OR, 4.61; 95% CI, 2.66-7.99; P < .0001), and being married (OR, 2.28; 95% CI, 1.42-3.65; P = .0006) for adults and a higher family income for children (OR, 4.99; 95% CI, 2.12-11.75; P = .0002). Importantly, pre-HCT PRO scores independently predicted survival after adjustments for patient-, disease-, and transplant-related factors. The adjusted probabilities of 1-year survival were 56%, 67%, 75%, and 76% by increasing quartiles of the pre-HCT FACT-BMT score and 58%, 72%, 62%, and 82% by increasing quartiles of the pre-HCT SF-36 physical component score. CONCLUSIONS A hybrid model of local consent for centralized PRO collection is feasible, and pretransplant PROs provide critical prognostic information for HCT outcomes. Cancer 2017;123:4687-4700. © 2017 American Cancer Society.
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Affiliation(s)
- Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ruta Brazauskas
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Heather R Millard
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rachel Fonstad
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Kathryn E Flynn
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Jenny Vogel
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Charney Petroske
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Deborah Mattila
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Rebecca Drexler
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - J Douglas Rizzo
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
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Bevans M, El-Jawahri A, Tierney DK, Wiener L, Wood WA, Hoodin F, Kent EE, Jacobsen PB, Lee SJ, Hsieh MM, Denzen EM, Syrjala KL. National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Patient-Centered Outcomes Working Group Report. Biol Blood Marrow Transplant 2017; 23:538-551. [PMID: 27660168 PMCID: PMC5346334 DOI: 10.1016/j.bbmt.2016.09.011] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 12/20/2022]
Abstract
In 2015, the National Institutes of Health convened six working groups to address the research needs and best practices for late effects of hematopoietic stem cell transplantation survivors. The Patient-Centered Outcomes Working Group, charged with summarizing the HRQOL evidence base, used a scoping review approach to efficiently survey the large body of literature in adult and pediatric HCT survivors over 1 year after transplantation. The goals of this paper are to (1) summarize the current literature describing patient-centered outcomes in survivors, including the various dimensions of health-related quality of life affected by HCT, and describe interventions tested to improve these outcomes; (2) highlight areas with sufficient evidence allowing for integration into standard practice; (3) address methodological issues that restrict progress in this field; (4) identify major gaps to guide future research; and (5) specify priority research recommendations. Patient-centered outcomes were summarized within physical, psychological, social, and environmental domains, as well as for adherence to treatment, and health behaviors. Interventions to improve outcomes were evaluated for evidence of efficacy, although few interventions have been tested in long-term HCT survivors. Methodologic issues defined included lack of consistency in the selection of patient-centered outcome measures, along with the absence of a standard for timing, frequency, and mode of administration. Recommendations for HCT survivorship care included integration of annual screening of patient-centered outcomes, use of evidence-based practice guidelines, and provision of treatment summaries and survivorship care plans after HCT. Three priority research recommendations included the following: (1) design and test risk-targeted interventions with dose-intensity modulation matching the needs of HCT survivors with priority domains, including sexual dysfunction, fatigue, sleep disruption, nonadherence to medications and recommended health care, health behaviors including physical inactivity and healthy eating, and psychological dysfunction, with particular consideration of novel technologies to reach HCT survivors distant from their transplantation centers; (2) design a consensus-based methodologic framework for outcomes evaluation; and (3) evaluate and compare existing practices for integrating patient-centered outcome screening and interventions across HCT survivorship programs.
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Affiliation(s)
- Margaret Bevans
- Nursing Department, National Institutes of Health Clinical Center, Bethesda, Maryland.
| | - Areej El-Jawahri
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - D Kathryn Tierney
- Division of Primary, Preventive and Community Medicine, Stanford University, Stanford, California
| | - Lori Wiener
- Psychosocial Support and Research Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - William A Wood
- Division of Hematology and Oncology, University of North Carolina, Durham, North Carolina
| | - Flora Hoodin
- Department of Psychiatry, University of Michigan & Department of Psychology, Eastern Michigan University, Ann Arbor, Michigan
| | - Erin E Kent
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Paul B Jacobsen
- Psychosocial and Palliative Care Program, Moffitt Cancer Center, Tampa, Florida
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Matthew M Hsieh
- Molecular and Clinical Hematology Branch, National Institutes of Health, National Heart Lung and Blood Institute, Bethesda, Maryland
| | - Ellen M Denzen
- National Marrow Donor Program/Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Mohammadi S, Malek Mohammadi A, Norooznezhad AH, Heshmati F, Alimoghaddam K, Ghavamzadeh A. Extra corporeal photochemotherapy in steroid refractory graft versus host disease: A review of guidelines and recommendations. Transfus Apher Sci 2017; 56:376-384. [PMID: 28359604 DOI: 10.1016/j.transci.2017.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/04/2016] [Accepted: 01/29/2017] [Indexed: 12/18/2022]
Abstract
Regardless of remarkable progresses in prevention and treatment approaches, graft versus host disease (GVHD) remains a major impediment for successful allogeneic hematopoietic stem cells transplantation (HSCT) and leads to morbidity and mortality in transplanted patients. Corticosteroids are the standard therapy for GVHD; however, a great number of patients will not respond sufficiently and others will be significantly affected by adverse effects of steroids. Extracorporeal photochemotherapy (ECP), as one of the numerous second line therapies, through modulation of immune cells may improves GVHD affected organ function in steroid-refractory forms. Considering to widespread utilization of ECP as a therapeutic strategy, we performed review on current literature of ECP, regarding the treatment strategies, monitoring protocols and technical aspects in chronic and acute GVHD.
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Affiliation(s)
- Saeed Mohammadi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashraf Malek Mohammadi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Norooznezhad
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Kamran Alimoghaddam
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardeshir Ghavamzadeh
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Ramsenthaler C, Kane P, Gao W, Siegert RJ, Edmonds PM, Schey SA, Higginson IJ. Prevalence of symptoms in patients with multiple myeloma: a systematic review and meta-analysis. Eur J Haematol 2016; 97:416-429. [PMID: 27528496 DOI: 10.1111/ejh.12790] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Multiple myeloma (MM) is an incurable haematological disease. Due to novel agents, overall survival has improved in this group, yet there are no systematic reviews to understand the symptom profiles resulting from disease and treatment-related toxicities. We aimed to synthesise data on the prevalence of symptoms in patients with MM. METHODS A systematic database and grey literature search were conducted in six databases. Random-effects meta-analysis with inverse variance weighting to pool prevalence data was performed. RESULTS Thirty-six studies were included of which 34 studies (N = 3023) provided data for meta-analysis. Twenty-seven distinct symptoms were reported, with the majority of studies focusing on pain (n = 27), fatigue (n = 19) and problems with functioning (n = 15). The most prevalent symptoms were fatigue (98.8%, 95% CI 98.1-99.2%), pain (73%, 39.9-91.7), constipation (65.2%, 22.9-92.2) and tingling in the hands/feet with 53.4% (0.4-99.7). The most common problems were decreased physical functioning (98.9%, 98.2-99.3), decreased cognitive functioning (80.2%, 40-96.1) and financial difficulties (78.4%, 39.1-95.4). These problems were present in newly diagnosed to advanced disease stage. CONCLUSIONS Optimal quality of life and good symptom management in this incurable disease can only be achieved by routinely assessing symptoms throughout the disease trajectory.
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Affiliation(s)
- Christina Ramsenthaler
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Faculty of Life Sciences and Medicine, King's College London, London, UK. .,Department of Palliative Medicine, Munich University Hospital, Munich, Germany.
| | - Pauline Kane
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Wei Gao
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Richard J Siegert
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Faculty of Life Sciences and Medicine, King's College London, London, UK.,Department of Psychology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Polly M Edmonds
- Department of Palliative Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Stephen A Schey
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Ernst J, Hinz A, Niederwieser D, Döhner H, Hönig K, Vogelhuber M, Mehnert A, Weissflog G. Dyadic coping of patients with hematologic malignancies and their partners and its relation to quality of life – a longitudinal study. Leuk Lymphoma 2016; 58:655-665. [DOI: 10.1080/10428194.2016.1194983] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jochen Ernst
- Medical Psychology & Medical Sociology, Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany
| | - Andreas Hinz
- Medical Psychology & Medical Sociology, Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany
| | - Dietger Niederwieser
- Division of Hematology and Oncology, University Hospital of Leipzig, Leipzig, Germany
| | - Hartmut Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
- Comprehensive Cancer Center Ulm (CCCU), Ulm, Germany
| | - Klaus Hönig
- Comprehensive Cancer Center Ulm (CCCU), Ulm, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany
| | - Martin Vogelhuber
- Department of Internal Medicine III, University of Regensburg, Regensburg, Germany
| | - Anja Mehnert
- Medical Psychology & Medical Sociology, Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany
| | - Gregor Weissflog
- Medical Psychology & Medical Sociology, Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany
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Shaw BE, Lee SJ, Horowitz MM, Wood WA, Rizzo JD, Flynn KE. Can we agree on patient-reported outcome measures for assessing hematopoietic cell transplantation patients? A study from the CIBMTR and BMT CTN. Bone Marrow Transplant 2016; 51:1173-9. [PMID: 27159181 DOI: 10.1038/bmt.2016.113] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/17/2016] [Accepted: 03/18/2016] [Indexed: 01/09/2023]
Abstract
Much research into the impact of hematopoietic cell transplantation (HCT) on recipients' symptoms, functioning and health-related quality of life uses diverse patient-reported outcome (PRO) measures. Robust conclusions regarding PROs in HCT patients are constrained by methodological issues, including the use of multiple different and noncomparable assessment measures. We reviewed 114 publications addressing PROs in HCT patients. Although three multi-item measures were most frequently used (FACT-BMT, n=28; European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30, n=26; and SF-36, n=26), 25 additional measures were used in more than one study. Another 50 measures were used in single studies. Over 50% of studies used more than one measure. We recommend that the field agrees upon a set of measures to address the core domains important to patients, to reduce heterogeneity and allow comparisons across studies and between different populations. Measures should be available in a free and easily accessible manner internationally. We discuss the relative benefits of the National Institutes of Health-supported Patient-Reported Outcomes Measurement Information System (PROMIS) system to achieve these goals. To further address these issues, the Blood and Marrow Transplant Clinical Trials Network has recently created a task force to implement PROMIS measures alongside traditional PRO measures in future clinical trials. Robust comparisons between measures in this setting may allow for the development of a standard for HCT patients.
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Affiliation(s)
- B E Shaw
- Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Froedert and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - S J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - M M Horowitz
- Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Froedert and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - W A Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - J D Rizzo
- Department of Medicine, CIBMTR (Center for International Blood and Marrow Transplant Research), Froedert and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - K E Flynn
- Department of Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA
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46
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El-Jawahri A, Vandusen H, Traeger L, Fishbein JN, Keenan T, Gallagher ER, Greer JA, Pirl WF, Jackson VA, Spitzer TR, Chen YBA, Temel JS. Quality of life and mood predict posttraumatic stress disorder after hematopoietic stem cell transplantation. Cancer 2016; 122:806-12. [PMID: 26650840 PMCID: PMC4788001 DOI: 10.1002/cncr.29818] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/27/2015] [Accepted: 11/09/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND During hospitalization for hematopoietic stem cell transplantation (HCT), patients experience a steep deterioration in quality of life (QOL) and mood. To our knowledge, the impact of this deterioration on patients' QOL and posttraumatic stress disorder (PTSD) symptoms after HCT is unknown. METHODS We conducted a prospective longitudinal study of patients hospitalized for HCT. They assessed QOL using the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT) and depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) at the time of admission for HCT, during hospitalization, and 6 months after HCT. We also used the Hospital Anxiety and Depression Scale (HADS) to measure patients' anxiety and depression symptoms at baseline and during HCT hospitalization. The PTSD Checklist was used to assess for PTSD symptoms. Multivariable linear regression models were used to identify predictors of QOL and PTSD symptoms at 6 months. RESULTS We enrolled 90 of 93 consecutively eligible patients (97%) undergoing autologous and allogeneic HCT. Data at 6 months were available for 67 participants. At 6 months, 28.4% of participants met the criteria for PTSD and 43.3% had clinically significant depression. On multivariable regression analyses adjusting for significant covariates, changes in QOL and depression scores from week 2 of HCT hospitalization to baseline predicted worse QOL (changes in scores between week 2 and baseline [Δ] QOL: β, 0.94 [P<.0001] and Δ PHQ-9: β, -2.59 [P = 0.001]) and PTSD symptoms (Δ QOL: β, -0.40 [P<.0001] and Δ PHQ-9: β, 1.26 [P<.0001]) at 6 months after HCT. CONCLUSIONS Six months after HCT, a significant percentage of patients met the criteria for PTSD and depression. A decline in QOL and an increase in depressive symptoms during hospitalization for HCT were found to be the most important predictors of 6-month QOL impairment and PTSD symptoms. Therefore, managing symptoms of depression and QOL deterioration during HCT hospitalization may be critical to improving QOL at 6 months and reducing the risk of PTSD. Cancer 2016;122:806-812. © 2015 American Cancer Society.
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Affiliation(s)
- Areej El-Jawahri
- Massachusetts General Hospital, Bone Marrow Transplant Program, 55 Fruit Street, Boston MA
| | - Harry Vandusen
- Massachusetts General Hospital, Bone Marrow Transplant Program, 55 Fruit Street, Boston MA
| | - Lara Traeger
- Massachusetts General Hospital, Department of Psychiatry, 55 Fruit Street, Boston MA
| | - Joel N. Fishbein
- Massachusetts General Hospital, Bone Marrow Transplant Program, 55 Fruit Street, Boston MA
| | - Tanya Keenan
- Massachusetts General Hospital, Department of Internal Medicine, 55 Fruit Street, Boston MA
| | - Emily R. Gallagher
- Massachusetts General Hospital, Bone Marrow Transplant Program, 55 Fruit Street, Boston MA
| | - Joseph A. Greer
- Massachusetts General Hospital, Department of Psychiatry, 55 Fruit Street, Boston MA
| | - William F. Pirl
- Massachusetts General Hospital, Department of Psychiatry, 55 Fruit Street, Boston MA
| | - Vicki A. Jackson
- Massachusetts General Hospital, Palliative Care Department, 55 Fruit Street, Boston MA
| | - Thomas R. Spitzer
- Massachusetts General Hospital, Bone Marrow Transplant Program, 55 Fruit Street, Boston MA
| | - Yi-Bin A. Chen
- Massachusetts General Hospital, Bone Marrow Transplant Program, 55 Fruit Street, Boston MA
| | - Jennifer S. Temel
- Massachusetts General Hospital, Department of Hematology-Oncology, 55 Fruit Street, Boston MA
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Braamse AMJ, Yi JC, Visser OJ, Heymans MW, van Meijel B, Dekker J, Syrjala KL. Developing a Risk Prediction Model for Long-Term Physical and Psychological Functioning after Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2015; 22:549-56. [PMID: 26685773 DOI: 10.1016/j.bbmt.2015.11.1102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/27/2015] [Indexed: 02/08/2023]
Abstract
Hematopoietic cell transplantation (HCT) is associated with impaired physical and psychological functioning for some long-term survivors. A risk prediction model would help clinicians estimate their patients' physical and psychological functioning after HCT and determine when to refer to added supportive care when appropriate. The purpose of the present study was to develop risk prediction models for physical and psychological functioning in HCT survivors. This was a secondary analysis of data from a randomized controlled trial (NCT00799461) that included 3- to 10-year HCT survivors. Risk predictions for physical and psychological functioning were developed by using backward logistic regression. The models were internally validated using bootstrapping techniques. Regression coefficients were converted into easy-to-use risk scores. Finally, the sensitivity, specificity, and positive and negative predictive values of the total risk score were calculated. The analyses included 489 survivors, with a mean age of 45.6 (SD, 12.4) years; 47% were female and with a mean of 6.1 years (SD, 2.0) after transplantation. Younger age, higher body mass index (BMI), no or part-time work, more comorbid diseases, autologous transplantation, and chronic graft-versus-host disease predicted impaired physical functioning. Female gender, younger age, higher BMI, not living with a partner, autologous transplantation, and chronic graft-versus-host disease predicted impaired psychological functioning. Although both models had predictive value for long-term functioning, diagnostic accuracy was moderate. For the physical functioning receiver operating characteristic, area under the curve (AUC) after internal validation was .74 with sensitivity 51.9 and specificity 82.8 at the optimal cut-off. For psychological functioning, AUC after internal validation was .69 with sensitivity 83.3 and specificity 42.9 at the optimal cut-off. We conclude that it is possible to predict long-term physical and psychological functioning with readily accessible, mostly pretransplantation predictors. The accuracy of the risk prediction models can be improved for use in clinical practice, potentially by adding pretransplantation patient-reported functioning and comorbidities.
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Affiliation(s)
- Annemarie M J Braamse
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands; Inholland University of Applied Sciences, Department of Health, Sports & Welfare/Cluster Nursing, Research Group Mental Health Nursing, Amsterdam, The Netherlands.
| | - Jean C Yi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Otto J Visser
- Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Berno van Meijel
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; Inholland University of Applied Sciences, Department of Health, Sports & Welfare/Cluster Nursing, Research Group Mental Health Nursing, Amsterdam, The Netherlands; Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Joost Dekker
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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48
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Kim KI, Kim JH, Ji EH, Jang JH, Kim JS, Kwon JH, Kim I, Park S, Velikova G, Yoon SS, Oh JM. Psychometric analysis of the Korean version of the high-dose chemotherapy specific quality of life questionnaire module from the European Organization for Research and Treatment of Cancer (EORTC QLQ-HDC29). Qual Life Res 2015; 25:881-90. [PMID: 26342931 DOI: 10.1007/s11136-015-1121-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE We evaluated the psychometric properties of the Korean version of the European Organization for Research and Treatment of Cancer high-dose chemotherapy specific quality of life questionnaire module (EORTC QLQ-HDC29) when implemented with Korean patients by conducting a multicenter, longitudinal study in three Korean hospitals. METHODS A total of 226 patients who scheduled to receive the HDC followed by hematopoietic stem cell transplantation (HSCT) were enrolled. The patients were asked to complete three questionnaires [the EORTC Core Questionnaire (QLQ-C30), QLQ-HDC29, and the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation] at four points in time: before HSCT and 100, 180, and 365 days after HSCT. Standard validity and reliability analyses were performed. RESULTS Internal consistency of the QLQ-HDC29 was generally acceptable, as tested by Cronbach's α, except for the scales body image and the inpatient issues. Cronbach's α values for the Korean version of the QLQ-HDC29 were almost in accordance with results of the original version, except for the scales body image (lower to the original QLQ-HDC29, α = 0.73) and impact on family (higher to the original QLQ-HDC29, α = 0.52). Known-group comparison analyses showed significantly higher symptom burdens in patients with poor performance status or graft versus host disease (similar to the original QLQ-HDC29). The QLQ-HDC29 indicated good convergent and discriminant validity and showed responsiveness to changes in line with a clinical course over time after HSCT. CONCLUSIONS The QLQ-HDC29 is generally reliable and adequate to assess QoL in Korean patients undergoing HDC followed by HSCT.
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Affiliation(s)
- Kyung Im Kim
- College of Pharmacy, Korea University, Sejong, Republic of Korea
| | - Jae Hyun Kim
- College of Pharmacy, Seoul National University, Seoul, Republic of Korea
| | - Eun Hee Ji
- College of Pharmacy, Gachon University, Incheon, Republic of Korea
| | - Jun Ho Jang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji-Hyun Kwon
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Inho Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seonyang Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Galina Velikova
- Cancer Research UK Clinical Centre - Leeds, St James's University Hospital, Leeds, UK
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. .,Cancer Research Institute, Seoul National University, Seoul, Republic of Korea. .,Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Jung Mi Oh
- College of Pharmacy, Seoul National University, Seoul, Republic of Korea. .,Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea.
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49
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Frödin U, Lotfi K, Fomichov V, Juliusson G, Börjeson S. Frequent and long-term follow-up of health-related quality of life following allogeneic haematopoietic stem cell transplantation. Eur J Cancer Care (Engl) 2015; 24:898-910. [DOI: 10.1111/ecc.12350] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2015] [Indexed: 12/29/2022]
Affiliation(s)
- U. Frödin
- Department of Hematology and Department of Medical and Health Sciences; Linköping University; Linköping
| | - K. Lotfi
- Department of Hematology and Department of Medical and Health Sciences; Linköping University; Linköping
| | - V. Fomichov
- Regional Cancer Center Southeast; County Council of Östergötland; Linköping
| | - G. Juliusson
- Department of Hematology and Coagulation and Stem Cell Center; Lund University; Lund Sweden
| | - S. Börjeson
- Department of Hematology and Department of Medical and Health Sciences; Linköping University; Linköping
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50
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Song CE, So HS. Factors Influencing Changes in Quality of Life in Patients undergoing Hematopoietic Stem Cell Transplantation: A Longitudinal and Multilevel Analysis. J Korean Acad Nurs 2015; 45:694-703. [DOI: 10.4040/jkan.2015.45.5.694] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 01/31/2015] [Accepted: 06/19/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Chi Eun Song
- Chonnam National University Hwasun Hospital, Chonnam, Korea
| | - Hyang Sook So
- College of Nursing, Chonnam National University, Gwangju, Korea
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