Evaluation of the health-related quality of life of hematopoietic stem cell transplantation patients

Hematopoietic Stem Cell Transplantation Impact on Patients' Perceived Quality of Life: A Longitudinal Study

OBJECTIVE

The aim of this paper was to evaluate the quality of life of adult patients with onco-hematological disease treated with hematopoietic stem cell transplantation up to two years post-transplantation.

METHOD

A quantitative, observational, longitudinal, and analytical study was conducted with 121 participants diagnosed with onco-hematological cancer who underwent hematopoietic stem cell transplantation between October 2017 and September 2019, with a 2-year post-transplantation follow-up, of whom only 39 completed the study. The Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT) questionnaire and its subscales, Functional Assessment of Cancer Therapy-General (FACT-BMT) and Functional Assessment of Cancer Therapy Trial Outcome Index (FACT-TOI), developed by the Functional Assessment of Chronic Illness Therapy (FACIT) and validated for Spain, were used to assess quality of life.

RESULT

The average age for hematopoietic stem cell transplantation was 54 years, with a majority of male participants. The evaluation of quality of life showed a decrease at the time of hospital discharge, followed by a progressive improvement up to one year after the transplantation. There was a significant difference in the quality of life questionnaire scores between both sexes during all stages of the research, with higher scores in male participants. The length of hospital stay significantly affected patients' physical and functional well-being, and marital status was related to differences in the perception of quality of life.

CONCLUSIONS

Despite the initial decrease in quality of life for patients undergoing hematopoietic stem cell transplantation, levels of quality of life similar to baseline are regained one year after the transplantation. Sociodemographic variables are related to how these patients perceive their quality of life. However, further studies with a larger sample size are needed for more precise results.

Evaluation of a Nurse-Led Patient Navigation Intervention: Follow-Up of Patients After Autologous and Allogeneic Stem Cell Transplantation

BACKGROUND

Complex survivorship cancer care requires nurse-led interventions. Therefore, a nurse-led patient navigation intervention was developed in which trained cancer nurses gave advice and referred to other professionals during the process of recovery and rehabilitation of hematopoietic stem cell transplantation (HSCT) patients.

OBJECTIVE

The aim of this study was to understand the nature and effect of this nurse-led information and referral intervention.

METHODS

Of the 199 included patients in the intervention group, 75 completed the quality of life, quality of care, self-efficacy, and self-management behavior questionnaires at baseline and at 6 and 12 months after HSCT. A historical control group of 62 patients completed the same questionnaires 12 months after HSCT. In addition, patients' experiences with the intervention were evaluated in 2 focus groups.

RESULTS

Patients emphasized the holistic approach of the cancer nurses and the opportunity to discuss psychosocial domains of life. Within the intervention group, a statistically significant effect on quality of life was demonstrated over time. The differences in quality of life, self-efficacy, and self-management were not significant between the intervention group and control group.

CONCLUSION

The holistic focus of this nurse-led intervention proved to be acceptable to the HSCT patients and promising in supporting the (complex) challenges that these patients face during their process of recovery and rehabilitation.

IMPLICATIONS FOR PRACTICE

Nurse-led patient navigation interventions with a holistic approach when included in the daily practice of complex survivorship cancer care can support HSCT patients' information and referral needs during their rehabilitation.

Five Phases of Recovery and Rehabilitation After Allogeneic Stem Cell Transplantation: A Qualitative Study

BACKGROUND

For patients with a hematological malignancy, allogeneic stem cell transplantation (alloSCT) is a treatment modality that may cause a wide range of problems. Little is known about the process of recovery and rehabilitation and the problems that alloSCT patients are confronted with during the first-year posttransplant.

OBJECTIVE

This study explored the problems of patients during the first year after alloSCT, to better understand the process of recovery and rehabilitation.

METHODS

In a qualitative study, hemato-oncology patients were interviewed 1-year posttransplant. The semistructured interviews were transcribed verbatim, coded, and analyzed using constant comparative analysis.

RESULTS

Ten participants were included until saturation of data was reached. The patients had experienced various problems and had gone through an individual process of recovery and rehabilitation. Nevertheless, 5 phases could be distinguished: (1) survive, (2) on the receiving end, (3) bring under control, (4) start recuperation, and (5) retrospection. The duration of each phase varied between patients.

CONCLUSION

Although patients experienced individual problems after alloSCT, they all followed a common pathway. Posttransplant care might be improved by adjusting the care to the distinct phases that the patients pass through.

IMPLICATIONS FOR PRACTICE

Nurses can play an important role in achieving improvements in posttransplant care by adjusting care to the individual needs of patients within the distinct phases.Future nursing research should confirm and refine this process of recovery and rehabilitation and assess the effects of improvement measures in alloSCT patients and in other populations.

QUALIDADE DE VIDA DOS CUIDADORES PRINCIPAIS DE PACIENTES PÓS-TRANSPLANTE DE CÉLULAS-TRONCO HEMATOPOÉTICAS

RESUMO Objetivo: avaliar e identificar os domínios afetados na qualidade de vida, correlacionar com a sobrecarga de cuidado e o desconforto emocional dos cuidadores principais de pacientes adultos com câncer hematológico submetidos ao transplante de células-tronco hematopoéticas. Método: estudo transversal e retrospectivo realizado com 59 cuidadores principais de pacientes submetidos a esta modalidade de tratamento. Foi caracterizado o perfil sociodemográfico e aplicado o questionário de avaliação de qualidade de vida (Medical Outcomes Study 36 - Item Short Form Health Survey), avaliação do desconforto emocional (Self Reporting Questionnaire) e de sobrecarga de cuidado (Zarit Burden Interview). Resultados: os participantes foram predominantes cuidadores principais do sexo feminino, cônjuges e com nível médio de escolaridade. Na avaliação da qualidade de vida foi observada correlação entre a Capacidade Funcional e Dor e entre Aspectos Emocionais e Saúde Mental. O maior escore apresentado pelo desconforto emocional não foi significativo. Em relação à sobrecarga de cuidado a maior frequência se deu entre sobrecarga moderada e moderada a grave. Conclusão: a qualidade de vida de cuidadores principais destes pacientes é prejudicada em diferentes domínios e a sobrecarga de cuidado é significativa; sugere-se que os cuidadores principais do paciente que realiza o transplante de células-tronco hematopoéticas sejam foco também da equipe multiprofissional que assiste o transplantado visando a promover a melhoria da qualidade de vida de ambos.

Epidemiologic Profile of Patients Transplanted With Hematopoietic Stem Cells in a Reference Service in the State of Rio Grande do Norte, Brazil

BACKGROUND

Hematopoietic stem cell transplantation (HSCT) consists of the intravenous infusion of healthy hematopoietic stem cells to restore the medullary and immunologic function of patients affected by a series of hematologic, oncologic, immunologic, malignant and nonmalignant inherited or acquired diseases, with the possibility of cure or increase of disease-free survival.

OBJECTIVE

To characterize the epidemiologic profile and the cases of death of patients who underwent HSCT.

METHODS

This is a cohort quantitative study, nested with a retrospective, descriptive, and analytical study of a hospital-based cohort that included the patients who underwent HSCT at a referral service in the state of Rio Grande do Norte, a region of northeastern Brazil.

RESULTS

There was a slight male prevalence (52.94%), the age of the patients ranged from 2 to 73 years old, 18.38% were brown, 47.06% were married, 15.07% were students, 78.31% had a diagnosis of multiple myeloma, 93.38% developed gastrointestinal toxicities, all patients received chemotherapeutic treatment, 54.78% had allogeneic HSCT, and the cause of the most recorded deaths was septic shock (48.19%).

CONCLUSIONS

This study showed relevant scientific evidence on the clinical and epidemiologic profile of patients who underwent HSCT. In general, sociodemographic data are similar to national and international research results.

Quality of life of patients with graft-versus-host disease (GvHD) post-hematopoietic stem cell transplantation

OBJECTIVE

Assessing the quality of life of adult patients with hematological cancer in the 100 days after transplantation of hematopoietic stem cells and verifying whether the variable graft-versus-host disease (GvHD) is predictive of worse results.

METHOD

An observational correlational and quantitative study with 36 adult participants diagnosed with hematologic cancer who underwent hematopoietic stem cell transplantation from September 2013 to June 2015.

RESULT

The mean age was 37 years, 52.78% were female, and 61.11% were diagnosed with leukemia. Quality of life scores showed a significant impact between pre-transplantation and pre-hospital discharge, and also within the 100 days post-transplantation. The statistical analysis between the scores for the groups with and without GvHD showed a significant difference between the presence of the complication and worse results.

CONCLUSION

Quality of life is altered as a result of hematopoietic stem cells transplantation, especially in patients who have graft-versus-host disease.

OBJETIVO

Avaliar a qualidade de vida de pacientes adultos com câncer hematológico nos 100 dias do transplante de células-tronco hematopoéticas e verificar se a variável doença do enxerto contra o hospedeiro é preditiva de piores resultados.

MÉTODO

Estudo observacional, correlacional e quantitativo, com 36 participantes adultos, diagnosticados com câncer hematológico que se submeteram ao transplante de células-tronco hematopoéticas de setembro de 2013 a junho de 2015.

RESULTADO

A média de idade foi 37 anos, 52,78% eram do sexo feminino, e 61,11% com diagnóstico de leucemia. Os escores de qualidade de vida demonstraram impacto significativo entre o pré-transplante e a pré-alta hospitalar e entre os 100 dias pós-transplante. A análise estatística entre os escores dos grupos com e sem doença do enxerto contra o hospedeiro evidenciou significância entre a presença desta complicação e piores resultados.

CONCLUSÃO

A qualidade de vida é alterada em decorrência do transplante de células-tronco hematopoéticas, em especial nos pacientes que apresentam doença do enxerto contra o hospedeiro.

Social impairment of patients undergoing hematopoietic stem cell transplant

OBJECTIVE

to evaluate the impairment of social and emotional domains of hospitalized patients undergoing hematopoietic stem cells transplantation.

METHOD

an observational, longitudinal study with 25 participants evaluated in the period of pre-transplant, pancytopenia and pre-hospital discharge between September 2013 and September 2014, in a reference hospital for this treatment modality in Brazil. Two international instruments were used, both of which translated and adapted to Portuguese (Brazil): Quality of Life Questionnaire-Core 30 and Functional Assessment Cancer Therapy - Bone Marrow Transplantation.

RESULTS

patients have shown a statistically significant decrease in the social domain, and stability of the emotional function along the course of treatment.

CONCLUSION

hematopoietic stem cell transplantation changes the social function of patients with hematologic cancer during hospitalization stage. Thus, patients should receive guidance addressing the social domain in order that it can be less affected.