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Joshi R, Garg A, Khan Z, Bhurani D, Nidhi, Khan MA. Short-Term Impact of Hematopoietic Stem Cell Transplantation on Depressive Behavior, Cognition and Quality of Life in Leukemia Patients. Indian J Hematol Blood Transfus 2024; 40:83-90. [PMID: 38312172 PMCID: PMC10831021 DOI: 10.1007/s12288-023-01653-2] [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: 10/16/2022] [Accepted: 03/25/2023] [Indexed: 02/06/2024] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) or Bone Marrow Transplantation (BMT) has significantly improved the survival rates of patients suffering from hematological malignancies. However, the cure can only be achieved at the price of morbidity and long-term complications. Thus, this study aimed to evaluate the short-term effect of HSCT on depressive behavior, cognition, and quality of life (QoL) in leukemia patients. Sixty patients were included in this prospective observational study. The current study assessed depression using Patient Health Questionnaire (PHQ-9) scale, cognition using Montreal Cognitive Assessment (MOCA) scale and QoL using European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30) before 7 days of the therapy i.e., preconditioning/baseline (TP1) and after 30 days of the treatment (TP2) in leukemia patients undergoing HSCT. At TP2, there was a significant improvement in PHQ-9 (p = 0.001), MOCA (p < 0.0001), functional scale (p < 0.0001) and global health & QoL scale (p = 0.001) of EORTC QLQ C30 scores whereas there was a significant decrease in symptom scale of EORTC QLQ C30 score (p = 0.005). Furthermore, at TP2 a statistically significant (p < 0.05) negative correlation was observed between MOCA and symptom scale of EORTC QLQ C30 after Pearson correlation analysis. In conclusion, post-30 days of HSCT there was alleviation in depressive behavior, cognition, and QoL in leukemia patients compared to before therapy. Graphical abstract
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Affiliation(s)
- Rhythm Joshi
- Centre for Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, 110062 India
| | - Aakriti Garg
- Centre for Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, 110062 India
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062 India
| | - Zehva Khan
- Centre for Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, 110062 India
| | - Dinesh Bhurani
- Department of Hemato-Oncology and Bone Marrow Transplantation, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, 110085 India
| | - Nidhi
- Centre for Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, 110062 India
| | - Mohd Ashif Khan
- Centre for Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, 110062 India
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Tao R, Chen Y, Kim S, Ocier K, Lloyd S, Poppe MM, Lee CJ, Glenn MJ, Smith KR, Fraser A, Deshmukh V, Newman MG, Snyder J, Rowe KG, Gaffney DK, Haaland B, Hashibe M. Mental health disorders are more common in patients with Hodgkin lymphoma and may negatively impact overall survival. Cancer 2022; 128:3564-3572. [PMID: 35916651 DOI: 10.1002/cncr.34359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 04/19/2022] [Accepted: 05/19/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Long-term mental health outcomes were characterized in patients who were diagnosed with Hodgkin lymphoma (HL), and risk factors for the development of mental health disorders were identified. METHODS Patients who were diagnosed with HL between 1997 and 2014 were identified in the Utah Cancer Registry. Each patient was matched with up to five individuals from a general population cohort identified within the Utah Population Database, a unique source of linked records that includes patient and demographic data. RESULTS In total, 795 patients who had HL were matched with 3575 individuals from the general population. Compared with the general population, patients who had HL had a higher risk of any mental health diagnosis (hazard ratio, 1.77; 95% confidence interval, 1.57-2.00). Patients with HL had higher risks of anxiety, depression, substance-related disorders, and suicide and intentional self-inflicted injuries compared with the general population. The main risk factor associated with an increased risk of being diagnosed with mental health disorders was undergoing hematopoietic stem cell transplantation, with a hazard ratio of 2.06 (95% confidence interval, 1.53-2.76). The diagnosis of any mental health disorder among patients with HL was associated with a detrimental impact on overall survival; the 10-year overall survival rate was 70% in patients who had a mental health diagnosis compared with 86% in those patients without a mental health diagnosis (p < .0001). CONCLUSIONS Patients who had HL had an increased risk of various mental health disorders compared with a matched general population. The current data illustrate the importance of attention to mental health in HL survivorship, particularly for patients who undergo therapy with hematopoietic stem cell transplantation.
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Affiliation(s)
- Randa Tao
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Yuji Chen
- Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Seungmin Kim
- Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Krista Ocier
- Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Shane Lloyd
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Matthew M Poppe
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Catherine J Lee
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Martha J Glenn
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Ken R Smith
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, United States
| | - Alison Fraser
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, United States
| | - Vikrant Deshmukh
- University of Utah Health Sciences Center, Salt Lake City, Utah, United States
| | - Michael G Newman
- University of Utah Health Sciences Center, Salt Lake City, Utah, United States
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, Utah, United States
| | - Kerry G Rowe
- Intermountain Healthcare, Salt Lake City, Utah, United States
| | - David K Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
| | - Ben Haaland
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, United States
| | - Mia Hashibe
- Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States
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Carofiglio F, Lopalco A, Lopedota A, Cutrignelli A, Nicolotti O, Denora N, Stefanachi A, Leonetti F. Bcr-Abl Tyrosine Kinase Inhibitors in the Treatment of Pediatric CML. Int J Mol Sci 2020; 21:ijms21124469. [PMID: 32586039 PMCID: PMC7352889 DOI: 10.3390/ijms21124469] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 02/07/2023] Open
Abstract
The therapeutic approach to Chronic Myeloid Leukemia (CML) has changed since the advent of the tyrosine kinase inhibitor (TKI) imatinib, which was then followed by the second generation TKIs dasatinib, nilotinib, and, finally, by ponatinib, a third-generation drug. At present, these therapeutic options represent the first-line treatment for adults. Based on clinical experience, imatinb, dasatinib, and nilotinib have been approved for children even though the studies that were concerned with efficacy and safety toward pediatric patients are still awaiting more specific and high-quality data. In this scenario, it is of utmost importance to prospectively validate data extrapolated from adult studies to set a standard therapeutic management for pediatric CML by employing appropriate formulations on the basis of pediatric clinical trials, which allow a careful monitoring of TKI-induced adverse effects especially in growing children exposed to long-term therapy.
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MESH Headings
- Child
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Fusion Proteins, bcr-abl/genetics
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Prognosis
- Protein Kinase Inhibitors/therapeutic use
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Affiliation(s)
| | | | | | | | | | | | - Angela Stefanachi
- Correspondence: (A.S.); (F.L.); Tel.: +39-08-0544-2783 (A.S.); +39-08-0544-2784 (F.L.)
| | - Francesco Leonetti
- Correspondence: (A.S.); (F.L.); Tel.: +39-08-0544-2783 (A.S.); +39-08-0544-2784 (F.L.)
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4
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Elwadhi D, Khandelwal SK, Kumar L, Sharma A. Short-Term Impact of Hematopoietic Stem Cell Transplantation on Psychiatric Morbidity and Quality of Life in Hematological Malignancies in Adults. Indian J Psychol Med 2020; 42:61-68. [PMID: 31997867 PMCID: PMC6970306 DOI: 10.4103/ijpsym.ijpsym_70_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/13/2019] [Accepted: 10/24/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) is an established treatment for a number of malignancies. Quality of life (QOL) is an important marker for assessing arduous treatment modalities. Diagnosis of cancer, HSCT, and the physical and psychosocial sequelae of the intensive treatment lead to a deficit in the QOL of the recipient. This study aimed to assess the impact of HSCT on psychiatric morbidity and QOL in patients with hematological malignancies. METHODS A longitudinal pre-post study was conducted at a cancer research center. Thirty patients with hematological malignancies were assessed at three different time points for psychiatric symptoms and QOL. Sociodemographic and clinical variables were collected using a semi-structured questionnaire. Comprehensive psychopathological rating scale was used to assess the psychiatric symptoms. WHO QOL Bref and cancer-specific European Organisation for Research and Treatment of Cancer Quality of life Questionnaire (EORTC-QLQ) were used to measure the quality of life. RESULTS The mean (SD) age of the sample was 42.3 (12.8) years, with 24 males and 6 females. Most patients reported anxiety and depressive symptoms, reaching a peak at 3 week post-HSCT. The maximum deficit in QOL scores was seen at 3 weeks, with further improvement at 3-month post-transplant. CONCLUSIONS HSCT leads to an increase in symptoms and a decrease in QOL during the acute phase. In the long run, it leads to improvement in physical and psychological wellbeing, with improvement in QOL. The recent surge in the long-term survivors of the procedure calls for further research in this direction so as to aid in their full recovery.
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Affiliation(s)
- Deeksha Elwadhi
- Department of Health Research, Holy Family Hospital, New Delhi, India
| | - S K Khandelwal
- Department of Psychiatry, Holy Family Hospital, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, AIIMS, New Delhi, India
| | - Atul Sharma
- Department of Medical Oncology, AIIMS, New Delhi, India
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Depression and anxiety following hematopoietic stem cell transplantation: a prospective population-based study in Germany. Bone Marrow Transplant 2017; 52:1651-1657. [PMID: 28892083 DOI: 10.1038/bmt.2017.190] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/06/2017] [Accepted: 07/29/2017] [Indexed: 01/11/2023]
Abstract
In this prospective multicenter study, we investigated the course of depression and anxiety during hematopoietic stem cell transplantation (HSCT) until 5 years after transplantation adjusting for medical information. Patients were consulted before HSCT (n=239), at 3 months (n=150), 12 months (n=102) and 5 years (n=45) after HSCT. Depression and anxiety were assessed with the Hospital Anxiety and Depression Scale (HADS). Detailed medical and demographic information was collected. Prevalence rates were compared with an age- and gender-matched control group drawn from a large representative sample (n=4110). The risk of depression before HSCT was lower for patients than for the control group (risk ratio (RR), 0.56; 95% confidence interval (CI), 0.39/0.81). Prevalence rates of depression increased from 12 to 30% until 5 years post HSCT. Anxiety rates were most frequently increased before HSCT (29%, RR, 1.31; 95% CI, 1.02/1.68) and then reached a stable level comparable to the background population (RR 0.83, 95% CI, 0.56/1.22). This study confirms the low levels of depression in the short term after HSCT and identifies depression as a long-term effect. Furthermore, it confirms previous results of heightened anxiety before HSCT. Surveillance of symptoms of anxiety during the short-term phase of HSCT and of depression during the following years is crucial.
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Sinatora F, Traverso A, Zanato S, Di Florio N, Porreca A, Tremolada M, Boscolo V, Marzollo A, Mainardi C, Calore E, Pillon M, Cattelan C, Basso G, Messina C. Quality of Life and Psychopathology in Adults Who Underwent Hematopoietic Stem Cell Transplantation (HSCT) in Childhood: A Qualitative and Quantitative Analysis. Front Psychol 2017; 8:1316. [PMID: 28848462 PMCID: PMC5550669 DOI: 10.3389/fpsyg.2017.01316] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/17/2017] [Indexed: 01/29/2023] Open
Abstract
Background: Patients who undergo pediatric Hematopoietic Stem Cell Transplantation (HSCT) may experience long-term psychological sequelae and poor Quality of Life (QoL) in adulthood. This study aimed to investigate subjective illness experience, QoL, and psychopathology in young adults who have survived pediatric HSCT. Method: The study involved patients treated with HSCT in the Hematology-Oncology Department between 1984 and 2007. Psychopathology and QoL were investigated using the SCL-90-R and SF-36. Socio-demographic and medical information was also collected. Finally, participants were asked to write a brief composition about their experiences of illness and care. Qualitative analysis of the texts was performed using T-LAB, an instrument for text analysis that allows the user to highlight the occurrences and co-occurrences of lemma. Quantitative analyses were performed using non-parametric tests (Spearman correlations, Kruskal-Wallis and Mann-Whitney tests). Results: Twenty-one patients (9 males) participated in the study. No significant distress was found on the SCL-90 Global Severity Index, but it was found on specific scales. On the SF-36, lower scores were reported on scales referring to bodily pain, general health, and physical and social functioning. All the measures were significantly (p < 0.05) associated with specific socio-demographic and medical variables (gender, type of pathology, type of HSCT, time elapsed between communication of the need to transplant and effective transplantation, and days of hospitalization). With regard to the narrative analyses, males focused on expressions related to the body and medical therapies, while females focused on people they met during treatment, family members, and donors. Low general health and treatment with autologous HSCT were associated with memories about chemotherapy, radiotherapy, and the body parts involved, while high general health was associated with expressions focused on gratitude (V-Test ± 1.96). Conclusion: Pediatric HSCT survivors are more likely to experience psychological distress and low QoL in adulthood compared with the general population. These aspects, along with survivors' subjective illness experience, show differences according to specific medical and socio-demographic variables. Studies are needed in order to improve the care and long-term follow-up of these families.
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Affiliation(s)
- Francesco Sinatora
- Psychiatric Unit, Department of Women's and Children's Health, University Hospital of PaduaPadua, Italy
| | - Annalisa Traverso
- Psychiatric Unit, Department of Women's and Children's Health, University Hospital of PaduaPadua, Italy
| | - Silvia Zanato
- Psychiatric Unit, Department of Women's and Children's Health, University Hospital of PaduaPadua, Italy
| | - Nicoletta Di Florio
- Psychiatric Unit, Department of Women's and Children's Health, University Hospital of PaduaPadua, Italy
| | - Alessio Porreca
- Psychiatric Unit, Department of Women's and Children's Health, University Hospital of PaduaPadua, Italy
| | - Marta Tremolada
- Department of Developmental Psychology and Socialisation, University of PaduaPadua, Italy
| | - Valentina Boscolo
- Psychiatric Unit, Department of Women's and Children's Health, University Hospital of PaduaPadua, Italy
| | - Antonio Marzollo
- Haematology-Oncology Division, Department of Women's and Children's Health, University Hospital of PaduaPadua, Italy
| | - Chiara Mainardi
- Haematology-Oncology Division, Department of Women's and Children's Health, University Hospital of PaduaPadua, Italy
| | - Elisabetta Calore
- Haematology-Oncology Division, Department of Women's and Children's Health, University Hospital of PaduaPadua, Italy
| | - Marta Pillon
- Haematology-Oncology Division, Department of Women's and Children's Health, University Hospital of PaduaPadua, Italy
| | - Chiara Cattelan
- Psychiatric Unit, Department of Women's and Children's Health, University Hospital of PaduaPadua, Italy
| | - Giuseppe Basso
- Haematology-Oncology Division, Department of Women's and Children's Health, University Hospital of PaduaPadua, Italy
| | - Chiara Messina
- Haematology-Oncology Division, Department of Women's and Children's Health, University Hospital of PaduaPadua, Italy
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Abstract
BACKGROUND Fatigue is highly prevalent after hematopoietic stem cell transplantation (HCT). It has been described as intense and may last for years following treatment. OBJECTIVE The aim of this study is to compare fatigue, physical activity, sleep, emotional distress, cognitive function, and biological measures in HCT survivors with persistent fatigue (n = 25) with age- and gender-matched healthy controls with occasional tiredness (n = 25). METHODS Data were collected using (a) objective, real-time assessments of physical activity and sleep over 7 days; (b) patient-reported fatigue assessments; (c) computerized objective testing of cognitive functioning; and (d) biological measures. Differences between groups were examined using multivariate analysis of variance. RESULTS Survivors of HCT reported increased physical (P < .001), mental (P < .001), and overall (P < .001) fatigue as well as increased anxiety (P < .05) and depression (P < .01) compared with healthy controls. Red blood cell (RBC) levels were significantly lower in HCT survivors (P < .001). Levels of RBC for both groups, however, were in the normal range. Tumor necrosis factor-α (P < .001) and interleukin-6 (P < .05) levels were significantly higher in HCT survivors. CONCLUSIONS Persistent fatigue in HCT survivors compared with healthy controls with occasional tiredness is accompanied by increased anxiety and depression along with decreased RBC counts. Elevated tumor necrosis factor-α and interleukin-6 levels may be important biomarkers. IMPLICATIONS FOR PRACTICE This study provides preliminary support for the conceptualization of fatigue as existing on a continuum, with tiredness anchoring one end and exhaustion the other. Persistent fatigue experienced by HCT survivors is more severe than the occasional tiredness of everyday life.
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8
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PROSE Treatment for Ocular Chronic Graft-Versus-Host Disease as a Clinical Network Expands. Eye Contact Lens 2017; 42:262-6. [PMID: 26448446 DOI: 10.1097/icl.0000000000000186] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Keratoconjunctivitis sicca occurs in 40% to 90% of patients with ocular chronic graft-versus-host disease (cGVHD). Ocular symptoms can have profound effects in both the visual function and quality of life of patients with GVHD. We report the impact of prosthetic replacement of the ocular surface ecosystem (PROSE) treatment in patients with cGVHD as a clinical network expands. METHODS We queried the BostonSight PROSE manufacturing database from January 2002 to December 2011. Patients treated for ocular cGVHD were reported by age, gender, year, and network site where the treatment was undertaken. The baseline and six-month follow-up scores of visual function using a standardized validated instrument, the National Eye Institute Visual Function Questionnaire (NEI VFQ-25), were evaluated for a period in 2006 and again in 2010 after network expansion had occurred. RESULTS A total of 407 patients with a male:female ratio of 226:181, mean age was 51 years with ocular cGVHD underwent PROSE treatment from January 2002 to December 2011. By 2011, 67% of all cases were treated at network clinics. Baseline characteristics of patients treated throughout the network in 2010 were similar to that of 2006 and 2010 cohorts from the main center. There was a significant improvement of 41 points (P<0.001) in composite NEI VFQ score among patients treated across the network in 2010, similar to the improvement of 30 points (P<0.001) seen among the patients treated at the main center in 2010. There was a trend toward lower baseline self-reported general health status (SRGHS) and VFQ scores among patients treated at network clinics, suggesting that expansion of the network allows treatment of sicker patients (lower general health status) or those more severely affected by ocular cGVHD. CONCLUSIONS PROSE treatment of ocular cGVHD has increased in the last decade with the establishment of BostonSight network clinics across the United States. Patients treated at network clinics showed similar levels of baseline visual function and SRGHS, and achieved a similar high level of improvement in visual function as those treated at the main center. Patient-reported measures of functional status are useful in evaluating treatment options for patients with cGVHD. PROSE treatment has significant positive impact on the visual function of patients with ocular cGVHD regardless of whether the patient is treated at the main center or at a network site.
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Yalvaç HD, Kotan Z, Tekgündüz E, Çayköylü A, Altuntaş F. Could psychiatric assessment before hematopoietic stem cell transplantation predict the need for psychiatric consultation during transplantation period? Transfus Apher Sci 2016; 54:85-90. [PMID: 26825282 DOI: 10.1016/j.transci.2016.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Psychiatric morbidity seems to be a significant concern associated with all stages of hematopoietic stem cell transplantation (HSCT). We aimed to understand whether psychiatric consultation before HSCT procedure could predict the need for psychiatric support during isolation period. Seventy-eight patients undergoing HSCT were included in the study. Patients were diagnosed according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). Standard anxiety and depression scores were performed. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and State and Trait Anxiety Inventory (STAI) were performed. Psychiatric consultation was required for 45 (58%) patients during hospitalization. Only pre-HSCT STAI trait scores were higher in patients who were found to have psychopathology at consultation during hospitalization compared to patients without established psychopathology. Sixteen (76%) and 29 (51%) patients needed consultation with and without pre-HSCT psychopathology, respectively. Our study showed that the psychiatric consultation request rate during the transplantation process was higher for cases previously diagnosed with psychopathology and who had high trait anxiety scale scores before HSCT.
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Affiliation(s)
- Hayriye Dilek Yalvaç
- Ankara Oncology Education and Research Hospital, Psychiatry Clinic, Ankara, Turkey.
| | - Zeynep Kotan
- Ankara Oncology Education and Research Hospital, Psychiatry Clinic, Ankara, Turkey
| | - Emre Tekgündüz
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
| | - Ali Çayköylü
- Yıldırım Beyazıt University Medical Faculty, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
| | - Fevzi Altuntaş
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic, Ankara, Turkey
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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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11
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Poloméni A, Lapusan S, Bompoint C, Rubio MT, Mohty M. The impact of allogeneic-hematopoietic stem cell transplantation on patients' and close relatives' quality of life and relationships. Eur J Oncol Nurs 2015; 21:248-56. [PMID: 26602410 DOI: 10.1016/j.ejon.2015.10.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 10/24/2015] [Accepted: 10/27/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE Although evidence suggests considerable disruption to families, the impact of allo-Hematopoietic Stem Cell Transplantation (HSCT) on patients' partners and close relatives has not been sufficiently explored. The present mixed-methods study aimed to enlighten allo-HSCT effects on patients' and close relatives' quality of life (QOL) and their relationships. METHODS Patients who received allo-HSCT between 2007 and 2010 (N = 58) and their close relatives (parents, partners and/or adult children) were asked to respond to an anonymous questionnaire including socio-demographic data, Likert-scale of the impact of HSCT on sexual, couple, family, professional and social life, as well as on perceived support. QOL of patients and close relatives was evaluated (by the FACT-BMT and by WHO-QOL-bref) as were the adjustments of the couples (patients/partners by the DAS). In-depth interviews were performed with patients and partners who consented to this proposition. RESULTS Patients (N = 28) and close relatives (N = 48) reported fatigue, sleep and sexual problems, emotional distress and relationship difficulties. Patients were mainly concerned with « being a burden » to their close relatives. Close relatives' main concerns were changes in marital and family dynamics, disruptions in daily routine tasks and the responsibility for being the main provider of physical and emotional care. These difficulties increased after HSCT - notably when patients have to face the long-term consequences of the procedure. CONCLUSION HSCT has a negative impact on patients' partners and other close relatives' QOL. Data on this topic is still scarce and this study might pave the way for future research in this field and notably guide psychosocial interventions.
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Affiliation(s)
- A Poloméni
- Département d'Hématologie clinique et thérapie cellulaire, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Fbg Saint Antoine, 75012 Paris, France.
| | - S Lapusan
- Département d'Hématologie clinique et thérapie cellulaire, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Fbg Saint Antoine, 75012 Paris, France.
| | - C Bompoint
- Département d'Hématologie clinique et thérapie cellulaire, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Fbg Saint Antoine, 75012 Paris, France.
| | - M T Rubio
- Département d'Hématologie clinique et thérapie cellulaire, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Fbg Saint Antoine, 75012 Paris, France.
| | - M Mohty
- Département d'Hématologie clinique et thérapie cellulaire, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Fbg Saint Antoine, 75012 Paris, France.
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Rueda-Lara M, Lopez-Patton MR. Psychiatric and psychosocial challenges in patients undergoing haematopoietic stem cell transplants. Int Rev Psychiatry 2014; 26:74-86. [PMID: 24716502 DOI: 10.3109/09540261.2013.866075] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Haematological malignancies are often treated with haematopoietic stem cell transplants (HSCT). The disease and its treatment are challenging and life threatening, as they not only affect the recipients, but also their families. This review highlights the available data on the psychological, psychiatric and social impact of these illnesses and their treatment on recipients and families. There are robust data that correlate HSCT with emotional distress, as emotional and physical functioning significantly affect quality of life. Psychiatric co-morbidity including anxiety, depression, adjustment and post-traumatic stress disorder, delirium and cognitive deficits have been reported at different stages in the transplant process. This review will highlight the psychosocial and clinical research findings relevant to HSCT patients and will summarize recommendations for future psychosocial research in this population.
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Affiliation(s)
- Maria Rueda-Lara
- University of Miami/Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Sylvester Comprehensive Cancer Center , Miami, Florida , USA
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Mo XD, Jiang Q, Xu LP, Liu DH, Liu KY, Jiang B, Jiang H, Chen H, Chen YH, Zhang XH, Han W, Wang Y, Huang XJ. Health-related quality of life of patients with newly diagnosed chronic myeloid leukemia treated with allogeneic hematopoietic SCT versus imatinib. Bone Marrow Transplant 2014; 49:576-80. [PMID: 24442252 DOI: 10.1038/bmt.2013.232] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 11/30/2013] [Accepted: 12/07/2013] [Indexed: 11/09/2022]
Abstract
To evaluate and compare the health-related quality of life (HRQOL) of patients with newly diagnosed CML in the first chronic phase (CML-CP1) receiving HLA-identical sibling donor (ISD) hematopoietic SCT (HSCT) or imatinib, a cross-sectional study that was part of a prospective cohort study at the Institute of Hematology, Peking University was performed. A total of 222 patients including 126 and 96 in the imatinib and ISD HSCT groups, respectively, were enrolled. HRQOL was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey. The ISD HSCT group functioned significantly better on the role-physical functioning and mental health subscales, as well as the mental component summary (MCS) than the imatinib group. HRQOL was generally comparable to groups in the young population. Multivariate analysis showed that white blood cell count ≥ 30 × 10(9)/L and plts count ≥ 450 × 10(9)/L were the major adverse factors affecting HRQOL in long-term survivors. Imatinib therapy was also an adverse factor affecting the MCS (odds ratio=1.7, P=0.032). Thus, long-term CML-CP1 survivors receiving ISD HSCT can attain desirable HRQOL comparable to or better than that of patients receiving imatinib.
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Affiliation(s)
- X-D Mo
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Q Jiang
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - L-P Xu
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - D-H Liu
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - K-Y Liu
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - B Jiang
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - H Jiang
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - H Chen
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Y-H Chen
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - X-H Zhang
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - W Han
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Y Wang
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - X-J Huang
- Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
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Polomeni A. Après le cancer, après la greffe, la GVHD : retentissements psychiques. PSYCHO-ONCOLOGIE 2013. [DOI: 10.1007/s11839-013-0403-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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15
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Efficace F, Cocks K, Breccia M, Sprangers M, Meyers C, Vignetti M, Baccarani M, Mandelli F. Time for a new era in the evaluation of targeted therapies for patients with chronic myeloid leukemia: Inclusion of quality of life and other patient-reported outcomes. Crit Rev Oncol Hematol 2012; 81:123-35. [DOI: 10.1016/j.critrevonc.2011.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 01/17/2011] [Accepted: 02/22/2011] [Indexed: 01/22/2023] Open
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Mosher CE, DuHamel KN, Rini C, Corner G, Lam J, Redd WH. Quality of life concerns and depression among hematopoietic stem cell transplant survivors. Support Care Cancer 2011; 19:1357-65. [PMID: 20661753 PMCID: PMC3760694 DOI: 10.1007/s00520-010-0958-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 07/12/2010] [Indexed: 12/31/2022]
Abstract
PURPOSE This study examined quality of life, transplant-related concerns, and depressive symptoms and their demographic and medical correlates at 1 to 3 years following hematopoietic stem cell transplantation (HSCT). METHODS HSCT survivors (N=406) completed telephone-administered questionnaires that assessed demographic variables, functional status, quality of life, transplant-related concerns, and depressive symptoms. RESULTS The most prevalent concerns among HSCT survivors included physical symptoms (e.g., fatigue and pain), maintaining current health status and employment, changes in appearance, and lack of sexual interest and satisfaction. In addition, almost one-third (32%) of survivors age 40 years and younger reported concern about their ability to have children. Unemployed survivors and those with lower incomes and worse functional status were more likely to experience poorer quality of life in multiple domains. Fifteen percent of the sample reported moderate to severe depressive symptoms, and these symptoms were higher among allogeneic transplant recipients and those with lower functional status. CONCLUSIONS Results suggest that interventions are needed to address physical symptoms, coping with an uncertain future, infertility, and sexual issues during the early phase of HSCT survivorship.
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Affiliation(s)
- Catherine E Mosher
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY 10022, USA.
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Predictors of health-related quality of life in patients treated with auto- and allo-SCT for hematological malignancies. Bone Marrow Transplant 2011; 47:757-69. [PMID: 21725373 DOI: 10.1038/bmt.2011.130] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Identifying factors that predict health-related quality of life (QOL) following hematopoietic SCT, is important in estimating patients' abilities to adjust to the consequences of their disease and treatment. As the studies that have been published on this subject are scattered, the present study aimed to systematically review prognostic factors for health-related QOL after auto- and allo-SCT in hematological malignancies. A systematic, computerized search in Medline, EMBASE, PsycINFO and the Cochrane Library was conducted from 2002 to June 2010. The methodological quality of the studies was assessed using an adaptation of Hayden's criteria list. Qualitative data synthesis was performed to determine the strength of the scientific evidence. In all, 35 studies fulfilled the selection criteria. Strong-moderate evidence was found for GVHD, conditioning regimen, being female, younger age, receiving less social support and pre-transplant psychological distress as predictors of various aspects of health-related QOL following hematopoietic SCT. The results of this review may help transplant teams in selecting patients at risk for experiencing a diminished health-related QOL following hematopoietic SCT. Follow-up treatment can be provided in order to promote QOL.
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Braamse AMJ, van Meijel B, Visser O, van Oppen P, Boenink AD, Eeltink C, Cuijpers P, Huijgens PC, Beekman ATF, Dekker J. Distress and quality of life after autologous stem cell transplantation: a randomized clinical trial to evaluate the outcome of a web-based stepped care intervention. BMC Cancer 2010; 10:361. [PMID: 20609251 PMCID: PMC2913960 DOI: 10.1186/1471-2407-10-361] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 07/07/2010] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Psychological distress (i.e. depression and anxiety) is a strong predictor of functional status and other aspects of quality of life in autologous stem cell transplantation following high-dose chemotherapy. Treatment of psychological distress is hypothesized to result in improvement of functional status and other aspects of quality of life. The aim is to evaluate the outcome of stepped care for psychological distress on functional status and other aspects of quality of life in patients with hematological malignancy treated with autologous stem cell transplantation. METHODS/DESIGN The study is designed as a randomized clinical trial with 2 treatment arms: a stepped care intervention program versus care as usual. Patients are randomized immediately pre transplant. Stepped care and care as usual are initiated after a 6 weeks buffer period. Outcome is evaluated at 13, 30, and 42 weeks post transplant.In the experimental group, the first step includes an Internet-based self-help program. If psychological distress persists after the self-help intervention, the second step of the program is executed, i.e. a diagnostic evaluation and a standardized interview, yielding a problem analysis. Based on this information, a contract is made with the patient and treatment is provided consisting of individual face-to-face counseling, medication, or referral to other services. Care as usual comprises an interview with the patient, on ad hoc basis; emotional support and advice, on ad hoc basis; if urgent problems emerge, the patient is referred to other services.Primary outcome variables are psychological distress and functional status. Data are analyzed according to the intention to treat-principle. DISCUSSION This study has several innovative characteristics. First, the outcome of the intervention for psychological distress in patients with hematological malignancy treated with autologous stem cell transplantation is evaluated in a randomized controlled study. Second, the impact of the intervention on functional status is evaluated: it is hypothesized that reduction of psychological distress results in improved functional status. Furthermore, the intervention concerns an Internet-based treatment in the first step. Finally, the intervention is characterized by an emphasis on self-management, efficiency, and a multi-disciplinary approach with nurses taking up a central role. TRIAL REGISTRATION NTR1770.
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Affiliation(s)
- Annemarie MJ Braamse
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Berno van Meijel
- Inholland University, Research Group Mental Health Nursing, Amsterdam, the Netherlands
| | - Otto Visser
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Patricia van Oppen
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Annette D Boenink
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Corien Eeltink
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, FPP, EMGO Institute for Health and Care Research, VU University, Amsterdam, the Netherlands
| | - Peter C Huijgens
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Aartjan TF Beekman
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Joost Dekker
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
- Department of Clinical Psychology, FPP, EMGO Institute for Health and Care Research, VU University, Amsterdam, the Netherlands
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Mosher CE, Redd WH, Rini CM, Burkhalter JE, DuHamel KN. Physical, psychological, and social sequelae following hematopoietic stem cell transplantation: a review of the literature. Psychooncology 2009; 18:113-27. [PMID: 18677717 DOI: 10.1002/pon.1399] [Citation(s) in RCA: 223] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This article reviews recent literature on adults' quality of life following hematopoietic stem cell transplantation (HSCT). METHODS We identified 22 prospective reports with at least 20 participants at baseline through a search of databases (Medline and PsycInfo) and handsearching of articles published from 2002 to October 2007. If longitudinal data were not available or were scarce for a particular topic or time point, cross-sectional studies were reviewed. RESULTS Although physical, psychological, and social aspects of quality of life tend to improve during the years following transplantation, a significant proportion of HSCT survivors experience persistent anxiety and depressive symptoms, fatigue, sexual dysfunction, and fertility concerns. Despite ongoing treatment side effects, the majority of HSCT survivors resume their work, school, or household activities. CONCLUSION We conclude that theory-driven research with larger samples is needed to identify subgroups of HSCT survivors with adjustment difficulties. Such research would examine survivors' evolving standards and definitions of quality of life to improve the accuracy and meaningfulness of assessment and incorporate biological, psychological, and contextual factors that may contribute to positive adjustment.
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Affiliation(s)
- Catherine E Mosher
- Memorial Sloan-Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, NY 10022, USA.
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Abstract
High-dose therapy with allogeneic hematopoietic cell transplantation (HCT) offers effective control and potential cure of hematopoietic malignancies, but with the cost of associated morbidity that includes adverse effects on quality of life (QOL). A growing body of literature has characterized this impact. Longitudinal studies suggest early moderate impairments that largely return to pretransplantation levels by day 100; the majority of studies suggest that greater than 60% of patients report good to excellent QOL in years 1 to 4 after HCT. Comparisons of allogeneic HCT with autologous HCT and standard-dose chemotherapy suggest impairments in QOL and a different trajectory of recovery in allogeneic HCT, but these conclusions are limited by confounding variables. Cross-sectional studies suggest larger and more persistent decrements in QOL in comparison with matched noncancer controls and population normative data. Acute and chronic graft-versus-host disease (GVHD) are significant threats to QOL. Behavioral interventions show promise to maintain or improve quality of life after allogeneic HCT. The review concludes with recommendations to investigators and clinicians as the state of this research advances.
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Moore CW, Rauch PK. Addressing parenting concerns of bone marrow transplant patients: opening (and closing) Pandora's box. Bone Marrow Transplant 2006; 38:775-82. [PMID: 17041607 DOI: 10.1038/sj.bmt.1705522] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although a significant number of adults undergoing stem cell transplant (SCT) or bone marrow transplantation (BMT) care for dependent children, and these treatments pose significant challenges for families, research has virtually ignored the impact of parenting on patients' quality of life during BMT/SCT and children's responses to having a parent undergo these treatments. Physicians rarely inquire about parenting concerns related to the extended hospitalizations necessitated by these treatments, yet clinical experience suggests that addressing patient concerns about children's reactions to cancer and BMT/SCT can improve the experience of the patient and the patient's family, and help the medical team respond effectively to sources of patients' distress. Parents frequently want to know what reactions to expect from children, thus general developmental information is reviewed, and recommendations given for when professional help for children is warranted. A key way for parents to support their children is with open, honest communication; however, parents often find it extremely difficult to talk about cancer and BMT/SCT with their children. The medical team can assist patients' efforts to communicate with and support their children by asking about a patient's children, providing some targeted information, and discussing the potential impact of treatments on parenting capacity. Inquiring about and addressing parenting concerns may initially seem difficult, but can ultimately facilitate stronger doctor-patient alliances, and more compassionate care.
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Affiliation(s)
- C W Moore
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA.
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Abstract
Abstract
The main objective of this study was to investigate whether patients with chronic myeloid leukemia (CML) in treatment with long-term therapy imatinib have a different health-related quality-of-life (HRQOL) profile compared with the general population. In total, 448 CML patients were enrolled, and the SF-36 Health Survey was used to compare generic HRQOL profiles. Symptoms were also assessed. HRQOL comparisons were adjusted for key possible confounders. The median age of patients was 57 years and the median time of imatinib treatment was 5 years (range 3-9 years). The largest HRQOL differences were found in younger patients. In particular, patients aged between 18 and 39 years had marked impairments in role limitations because of physical and emotional problems, respectively: −22.6 (P < .001), −22.3 (P < .001). Patients with CML age 60 or older had a HRQOL profile very similar to that reported by the general population. Women had a worse profile than men when each were compared with their peers in the general population. Fatigue was the most frequently reported symptom. The HRQOL of CML patients is comparable with that of population norms in many areas, however, younger and female patients seem to report the major limitations.
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