Longitudinal Analysis of the Relationships Between Social Support and Health-Related Quality of Life in Hematopoietic Stem Cell Transplant Recipients

A prospective study of the relationship between illness perception, depression, anxiety, and quality of life in hematopoietic stem cell transplant patients

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.

Relationship between fear of progression and symptom burden, disease factors and social/family factors in patients with stage-IV breast cancer in Shandong, China

OBJECTIVE

To assess fear of progression (FoP)'s relationship with symptom burden and disease and social/family factors, as well as, determine the status of FoP in women with stage-IV breast cancer in Shandong, China.

METHODS

Two hundred and sixteen women were recruited from the department of breast cancer internal medicine, Shandong Cancer Hospital and Institute. Data for this observational study were collected between October 2020 and January 2021 using the MD Anderson Symptom Inventory, the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) and a participant information scale. SPSS 23.0 was used for statistical analysis.

RESULTS

After excluding invalid responses, the data of 200 participants were analysed. The average total FoP-Q-SF score was 29.39 ± 9.39 (95% confidence interval, 21.81-27.64). The FoP level among the participants was relatively low. For disease and social/family factors, FoP statistically significantly differed by satisfaction with family emotional support and the Eastern Cooperative Oncology Group (ECOG) score. The ECOG score was positively correlated with FoP. Furthermore, symptom burden was positively correlated with FoP.

CONCLUSIONS

Among patients with stage-IV breast cancer, satisfaction with family emotional support, ECOG score and symptom burden play key roles in FoP. Interventions, including providing appropriate emotional support from family, improving physical fitness and relieving symptom burden, must be considered in future studies, which may improve patients' overall physical and mental status and provide a supportive therapeutic environment.

Loneliness, immunological recovery patterns, and health-related quality of life (HRQOL) outcomes in patients receiving hematopoietic stem cell transplantation

PURPOSE

Loneliness may compromise health-related quality of life (HRQOL) outcomes and the immunological impacts of loneliness via neuroendocrinological mechanisms likely have consequences for patients who have undergone a hematopoietic stem cell transplantation (HSCT).

RESEARCH APPROACH AND MEASURES

Loneliness (pre-transplant), immunological recovery (Day 30, Day 100, 1-year post-transplant), and HRQOL (Day 100, 1 year) were measured in a sample of 205 patients completing a HSCT (127 autologous, 78 allogenic).

RESULTS

Greater levels of pre-transplant loneliness predicted poorer HRQOL at Day 100 and 1-year follow-up. Loneliness also was associated with higher absolute neutrophil to absolute lymphocyte (ANC/ALC) ratios in the entire sample at Day 30, which in turn was associated with Day 100 HRQOL.

CONCLUSIONS

Findings demonstrate that pretransplant loneliness predicts HRQOL outcomes and associates with inflammatory immunological recovery patterns in HSCT patients. The balance of innate neutrophils to adaptive lymphocytes at Day 30 present a distinct profile in lonely individuals, with this immunity recovery profile predicting reduced HRQOL 100 days after the transplant. Addressing perceptions of loneliness before HSCT may be an important factor in improving immunological recovery and HRQOL outcomes.

Psychological empowerment and quality of life in haematopoietic stem cell transplantation patients: A quantitative study

AIM

This study aimed to evaluate the relationship between psychological empowerment, depression, anxiety, and quality of life in people with haematopoietic stem cell transplantation (HSCT).

DESIGN

A longitudinal prospective study.

METHODS

A sample of 150 people with haematological was recruited at Santaros Clinics in Lithuania between September 2020 and April 2022. Demographic characteristics, cancer-related characteristics, depression, anxiety, psychological empowerment and quality of life (QoL) were assessed using self-report questionnaires before and 10-12 weeks after HSCT. Descriptive statistics, correlation and moderation analyses were performed.

RESULTS

The results showed that psychological empowerment had a significant correlation with patients' depression, anxiety and QoL. Patients who were more empowered before HSCT had a subjectively better QoL before and after HSCT and were less depressed after transplantation. The results showed that empowerment was a moderator between depression and QoL after transplantation, but it had a significant effect on the QoL only among patients who are less depressed.

PATIENT OR PUBLIC CONTRIBUTION

With this study, we aim to contribute to a better understanding of the psychological experiences of people with HSCT. Particularly, psychological empowerment is an important factor in preparing for this treatment. Medical professionals like nurses can be crucial contributors to implementing and strengthening psychological empowerment.

Facilitators and obstacles to couples' intimacy after hematopoietic stem cell transplantation: a qualitative study

To identify perceived factors related to intimacy following HSCT.

Qualitative descriptive design.

Patients diagnosed with hematological cancer, 6 months into their HSCT recovery, and their partners.

Semi-structured interviews were conducted with 18 participants (nine patients and their partners). A thematic analysis was carried out.

Couples reported various obstacles to intimacy, such as emotional obstacles (i.e. negative emotions, emotional mismatch), the length of the disease, its treatments and side effects, and the patient's physical condition. Couples also reported facilitators to intimacy, such as using emotional facilitators (e.g. showing empathy), fostering open communication or sharing common experience of the disease.

This study highlights specific factors that influence couples' intimacy in the context of HSCT.Implications for Psychosocial Providers: Couples' intervention delivered in cancer care should be adapted by focusing on specific factors that maintain or enhance couples' intimacy.

Social support as a moderator of healthcare adherence and distress in long-term hematopoietic cell transplantation survivors

BACKGROUND

Treatment with hematopoietic cell transplantation (HCT) has potentially severe effects on physical and psychosocial functioning. Poor social support has been linked with physical morbidity and mortality as well as psychological distress in HCT survivors. This study tested a theory-driven hypothesis that social support buffers adverse effects of health stressors of comorbidities and graft-versus-host disease (cGVHD) on distress and adherence to recommended healthcare among long-term HCT survivors.

METHODS

This cross-sectional study analyzed baseline data from a randomized controlled trial in adult survivors 3-18 years post-HCT. Data included medical records and patient-reported outcomes including cancer and treatment distress (CTXD), healthcare adherence (HCA), comorbidity index, cGVHD, ENRICHD Social Support Instrument (ESSI), Social Activity Log, and Health Self-Efficacy. We tested hypothesized models for HCA and CTXD using blocked hierarchical linear regressions.

RESULTS

Among the 781 HCT survivors completing baseline assessment, 38% had > 3 comorbidities, 8% had moderate-severe cGVHD, 30% reported low social support, 30% reported elevated distress, and 49% reported low healthcare adherence. Social support and self-efficacy were directly related to both adherence and distress. Regression models supported the hypothesized moderated relationships for distress but not for healthcare adherence.

CONCLUSIONS

The two tested models confirm that the health stressors of comorbidities and cGVHD are moderated by better social support and self-efficacy in their associations with lower distress but without moderating effects for healthcare adherence.

IMPLICATIONS FOR CANCER SURVIVORS

Social support and self-efficacy confer protective benefits on healthcare adherence and psychological distress. Interventions are needed that focus on maintaining social networks or finding new networks if necessary.

CLINICAL TRIAL REGISTRATION NUMBER

NCT00799461.

Assessment of quality of life three years from hematopoietic stem cell transplant

OBJECTIVE

To assess the domains of quality of life related to hematologic cancer patient health in the first three years from autologous and allogeneic hematopoietic stem cell transplantation.

METHOD

A prospective cohort from September 2013 to February 2019 at a reference service in Latin America with 55 patients. The instruments Quality of Life Questionnaire Core C30 and Functional Assessment Cancer Therapy - Bone Marrow Transplantation were used. For data analysis, Generalized Linear Mixed Model was used.

RESULTS

The domains global and overall quality of life presented the lowest scores in the pancytopenia phase: 59.3 and 91.4 in autologous, 55.3 and 90.3 in allogeneic. The mixed method analysis has shown that there was a significant change in scores between the phases throughout the treatment (p< 0.05).

CONCLUSION

Health-related quality of life presented significant changes in the domains between the phases throughout time. Understanding these results enables nursing interventions directed at the domains which were damaged during treatment.

Quality of life and changes in the social dimension of hematopoietic stem cell transplants recipients

OBJECTIVES

to assess/correlate health-related quality of life with the social dimension of hematopoietic, autologous and allogeneic stem cell transplant patients in the three years post-transplant.

METHODS

longitudinal, observational study with 55 patients, in a reference hospital in Latin America, from September 2013 to February 2019, using the Quality of Life Questionnaire-Core and Functional Assessment Cancer Therapy Bone Marrow Transplantation.

RESULTS

A total of 71% underwent allogeneic transplantation. The social dimension had low averages since the baseline stage (55, 21) and low scores (56) for quality of life in pancytopenia. There was a significant positive correlation between social dimension, quality of life in pancytopenia (p<0.01) and follow-up after hospital discharge (p<0.00). There is a significant difference (p<0.00) throughout the stages, however, not in terms of the type of transplant (p>0.36/0.86).

CONCLUSIONS

patients with better assessments in the social dimension have a better quality of life. Interventions focusing on the multidimensionality of the quality of life construct are necessary.

Risk Factors for Hematopoietic Stem Cell Transplantation-Associated Bone Loss

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.

Changes in social support among patients with hematological malignancy undergoing hematopoietic stem cell transplantation in Souzhou, China

Background

Evidence regarding social support in patients is mostly from cross-sectional studies. Very few studies have focused on the change in social support systems before and after hematopoietic stem cell transplantation.

Methods

A total of 191 patients were investigated before transplantation and at 30, 90 and 180 days post-transplantation. The social support for patients was evaluated by the Perceived Social Support Scale (PSSS).

Results

The overall PSSS scores showed a continuous decline in means from 71.29 ± 9.73 before the transplantation to 69.44 ± 10.61, 68.73 ± 10.04, and 66.37 ± 12.02 at 30, 90 and 180 days post-transplantation, respectively. In comparison to the baseline, the overall PSSS scores decreased significantly at 90 and 180 days post-transplantation (P < .05). The Generalized Estimated Equation (GEE) analysis found that patients with no transplant-related complications, higher household income, and better educational status had preferable social support.

Conclusion

Social support presented a marked downward trend during the six month period. Patients with no transplant-related complications, higher household income and better educational status had preferable social support. Therefore, social support as a high-priority quality of life should be given close attention in the early phase of transplantation. Positive measures should be taken to improve social support in the early phase of transplantation especially among individuals undergoing this procedure for the first time.

Patient ambassador support: Experiences of the mentorship between newly diagnosed patients with acute leukaemia and their patient ambassadors

Objective

The study explores how newly diagnosed patients with acute leukaemia and their patient ambassadors experience the mentorship during the patient ambassador support programme.

Methods

Explorative semi‐structured individual interviews (n = 28) were carried out in patients with acute leukaemia (n = 15) and their patient ambassadors (n = 13). Interpretive description was the methodological framework used for the thematic analysis of the qualitative interview data.

Results

Identified themes were as follows: (a) exchanging life experiences (subthemes: individualised support and a meaningful return); (b) existential cohesion; (c) interreflection; and (d) terms and conditions (subtheme: break in journey). Patients experienced a feeling of being understood, the cohesion leading to hope and a feeling of being able to cope with their situation. Patient ambassadors experienced a sense of meaningfulness and gratitude for life.

Conclusions

Patients and patient ambassadors experienced benefits from the individualised support. Their shared experiences created a connection and mutual mirroring, which led to a sense of hope and gratitude for life. Initiatives that introduce peer‐to‐peer support in newly diagnosed patients with acute leukaemia as part of treatment and in daily clinical practice are crucial. Future studies should further examine the feasibility of peer‐to‐peer support interventions along the trajectory of acute leukaemia.

Factors influencing fear of cancer recurrence in patients with breast cancer: Evidence from a survey in Yancheng, China

AIM

To identify the characteristics of fear of cancer recurrence (FCR) in breast cancer patients after surgery and investigate the relationship of FCR with demographic and medical characteristics, quality of life (QOL) and social support.

METHODS

The short version of the Fear of Progression Questionnaire (FoP-Q-SF), the functional assessment of cancer therapy for breast cancer (FACT-B) and the Social Support Rating Scale were administered to the 342 breast cancer patients who had undergone surgical treatment. The analysis was performed to determine potential predictors associated with FCR.

RESULTS

Of the 465 patients, 342 (73.5%) agreed to take part in the study. The mean age of participants was 51.46 ± 10.50 years (range, 30-81). Of the 342 participants, 92 (26.9%) cases were at Stage I, 131 (38.3%) cases at Stage II, 34 (9.9%) patients at Stage III and 85 (24.9%) patients at Stage IV. Among the 12 items of the FoP-Q-SF, the three greatest fears were: Item 10 'Worrying that medications could damage the body', Item 1 'Being afraid of disease progression' and Item 2 'Being nervous prior to doctors' appointments or periodic examinations'. About 68.4% of patients reported the dysfunctional level of fear of progression. Multiple linear regression analysis showed that religious belief, family income, disease stages, social support, QOL were identified as independent predictors for FCR.

CONCLUSION

We found that FCR is prevalent in postoperative breast cancer patients, and is influenced by many factors. It is necessary to implement positive intervention measures to alleviate the FCR and improve the QOL of patients.