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McErlean G, Tapp C, Brice L, Pradhan A, Gilroy N, Kabir M, Greenwood M, Larsen SR, Moore J, Gottlieb D, Hertzberg M, Brown L, Hogg M, Huang G, Ward C, Kerridge I. Decisional Regret in Long-Term Australian Allogeneic Hematopoietic Stem Cell Transplantation Survivors: A Cross-Sectional Survey. Clin Nurs Res 2023; 32:1134-1144. [PMID: 37329124 PMCID: PMC10504814 DOI: 10.1177/10547738231180337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an intensive but effective treatment for malignant and non-malignant diseases. However, long-term survival often comes at a cost, with survivors experiencing chronic morbidity and are at risk of relapse and secondary malignancy. This study aimed to describe decisional regret in a large cohort of Australian long-term allo-HSCT survivors. A cross-sectional survey was conducted with 441 adults in New South Wales, assessing quality of life (QoL), psychological, social, demographic, and clinical variables. Less than 10% of survivors expressed regret, with chronic graft-versus-host disease being the most important clinical factor. Psycho-socioeconomic factors such as depression, lower QoL scores, lower household income, higher treatment burden, and not resuming sex post-HSCT were also associated with regret. Findings highlight the need for valid informed consent and ongoing follow-up and support for allo-HSCT survivors dealing with life post-transplant. Nurses and healthcare professionals play a critical role in addressing decisional regret in these patients.
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Affiliation(s)
- Gemma McErlean
- University of Wollongong, Sydney, NSW, Australia
- New South Wales Agency for Clinical Innovation, Sydney, Australia
| | - Caley Tapp
- University of Queensland, Herston, Australia
- Queensland Centre for Mental Health Research, Wacol, Australia
| | - Lisa Brice
- Royal North Shore Hospital, Sydney, NSW, Australia
| | | | - Nicole Gilroy
- New South Wales Agency for Clinical Innovation, Sydney, Australia
- Westmead Hospital, Sydney, NSW, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Sydney, NSW, Australia
| | - Matt Greenwood
- Royal North Shore Hospital, Sydney, NSW, Australia
- University of Sydney, NSW, Australia
| | | | - John Moore
- St Vincents Hospital, Sydney, NSW, Australia
| | - David Gottlieb
- Westmead Hospital, Sydney, NSW, Australia
- University of Sydney, NSW, Australia
| | | | - Louisa Brown
- Calvary Mater Hospital, Newcastle, NSW, Australia
| | - Megan Hogg
- Westmead Hospital, Sydney, NSW, Australia
| | | | - Christopher Ward
- Royal North Shore Hospital, Sydney, NSW, Australia
- University of Sydney, NSW, Australia
| | - Ian Kerridge
- Royal North Shore Hospital, Sydney, NSW, Australia
- University of Sydney, NSW, Australia
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McErlean G, Tapp C, Brice L, Gilroy N, Kabir M, Greenwood M, Larsen SR, Moore J, Gottlieb D, Hertzberg M, Brown L, Hogg M, Huang G, Ward C, Kerridge I. Predictors of post traumatic growth in allogeneic hematopoietic stem cell transplantation survivors: a cross-sectional survey. BMC Psychol 2023; 11:235. [PMID: 37587508 PMCID: PMC10433676 DOI: 10.1186/s40359-023-01204-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/09/2023] [Indexed: 08/18/2023] Open
Abstract
AIMS Given the increasing number of Hematopoietic Stem Cell Transplantations (HSCT) performed world-wide, the increasing likelihood of survival following HSCT, and the profound physical, psychosocial, and emotional impact of HSCT on survivors, their carers and families, it is important to identify factors that may contribute to or support post-traumatic growth (PTG) after transplant. In this study, we aimed to investigate the prevalence of PTG in an Australian cohort of long-term allogeneic HSCT survivors and describe associations between PTG and relevant clinical, sociodemographic and psychological variables. METHODS This was a large, multi-centre, cross sectional survey of Australian HSCT-survivors inviting all those transplanted in New South Wales between 2000 and 2012. Respondents completed the PTG Inventory (PTGI), the Sydney Post-BMT Survey, FACT-BMT, DASS 21, The Chronic Graft versus Host Disease (GVHD) Activity Assessment-Patient Self-Report (Form B), the Lee Chronic GVHD Symptom Scale, and the Fear of Cancer Recurrence Scale. Data was analysed using independent t-tests, one-way analysis of variance, and pearson's correlations, and hierarchical multiple regression adjusted for potential confounders and to ascertain independent associations of explanatory variables with PTG. RESULTS Of 441 respondents, 99% reported some level of PTG with 67% reporting moderate to high levels of PTG. Female gender, younger age, complementary therapy use, anxiety, psychological distress and psychosocial care, and higher quality of life were associated with higher levels of PTG. Importantly, we also found that PTG was not associated with either chronic GVHD or post-HSCT morbidity. CONCLUSIONS In this study - the largest study of PTG in long-term allogeneic HSCT survivors - we found that growth appears ubiquitous, with 99% of survivors reporting some degree of PTG and 67% reporting moderate-high levels of PTG. Importantly, we found no association with GVHD or chronic physical post-HSCT morbidity, or adverse financial, occupational or sexual impacts. This suggests that it is the necessity for and experience of, HSCT itself that foments personal growth. Accordingly, healthcare professionals should be alert to the profound and wide-ranging impact of HSCT - and the degree to which survivor's may experience PTG. Identifying interventions that may assist HSCT survivors cope and building their resilience is of utmost importance.
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Affiliation(s)
- Gemma McErlean
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.
| | - Caley Tapp
- School of Public Health, University of Queensland, Herston, QLD, Australia
- Queensland Centre for Mental Health Research, Wacol, QLD, Australia
| | - Lisa Brice
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Nicole Gilroy
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, NSW, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Sydney, NSW, Australia
| | - Matt Greenwood
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
- Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Stephen R Larsen
- Institute 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, Sydney, NSW, Australia
| | - Louisa Brown
- Department of Haematology, Calvary 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
| | - Christopher Ward
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
- Northern Blood Research Centre, Kolling Institute, University of Sydney, 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, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
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McErlean G, Brice L, Gilroy N, Kabir M, Greenwood M, Larsen SR, Moore J, Gottlieb D, Hertzberg M, Brown L, Hogg M, Huang G, Ward C, Kerridge I. Long-term treatment burden following allogeneic blood and marrow transplantation in NSW, Australia: a cross-sectional survey. J Cancer Surviv 2021; 16:432-444. [PMID: 33813667 DOI: 10.1007/s11764-021-01038-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Allogenic blood and marrow transplant (allo-BMT) is an arduous treatment used increasingly for many life-threatening conditions. Recognition of the profound impacts of the long term and late effects is ever-growing, as is the healthcare workload (treatment burden) of survivorship. PURPOSE To quantify the treatment burden of long-term survival following allo-BMT, regarding the range of health services, therapies and investigations accessed by survivors. METHODS A large, multi-centre cross-sectional survey of adult allo-BMT survivors transplanted between 2000 and 2012 in Sydney, Australia. Participants completed six validated instruments and one purposed designed for the study, the Sydney Post BMT Study (SPBS), answering questions relating to medication use, medical treatments, referrals, assessments and frequency of hospital/clinic attendance. RESULTS Of the 441 allo-BMT survivors, over a quarter who were more than 2 years post BMT attended the hospital clinic at least monthly, and 26.7% required a number of regular medical procedures (e.g. venesection, extracorpororeal photopheresis). Specialist medical and allied health referral was very common, and compliance with internationally recommended long-term follow-up (LTFU) care was suboptimal and decreased as time from BMT increased. CONCLUSION Respondents reported a large medication (conventional and complementary), screening, assessment and health care burden. IMPLICATIONS FOR CANCER SURVIVORS Treatment burden contributes significantly to the 'workload' of survivorship and can have a severe and negative impact on BMT survivors, carers and the healthcare system-making it difficult to comply with optimal care. Clinicians must be primed with skills to identify survivors who are overburdened by the health care required for survival and develop strategies to help ease the burden.
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Affiliation(s)
- Gemma McErlean
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia. .,Cancer Services, South Western Sydney Local Health District, Sydney, NSW, Australia. .,Centre for Applied Nursing Research and Ingham Institute of Applied Medical Research, Sydney, NSW, Australia. .,Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia.
| | - 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.,Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, NSW, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Sydney, NSW, Australia
| | - Matt Greenwood
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Stephen R Larsen
- Institute 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, Randwick, NSW, Australia
| | - Louisa Brown
- Department of Haematology, Calvary 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
| | - Christopher Ward
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, 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, Sydney, NSW, Australia.,Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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5
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Brice L, McErlean G, Donovan C, Tapp C, Gilroy N, Kabir M, Greenwood M, Larsen SR, Moore J, Gottlieb D, Hertzberg M, Brown L, Hogg M, Huang G, Tan J, Ward C, Kerridge I. Fear of cancer recurrence following allogeneic haematopoietic stem cell transplantation (HSCT) for haematological malignancy: A cross-sectional study. Eur J Oncol Nurs 2020; 49:101845. [PMID: 33128994 DOI: 10.1016/j.ejon.2020.101845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/29/2020] [Accepted: 09/30/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE The aim of this study was to quantify the prevalence of Fear of Cancer Recurrence (FCR) in patients with a prior haematology malignancy surviving more than one year post allogeneic haematopoietic stem cell transplantation (HSCT), and to identify the demographic, medical and psychological factors associated with FCR occurrence. METHOD Participants were adult allogeneic HSCT recipients who had undergone the procedure for acute leukaemia or other haematological malignancy between the years 2000-2012 in Sydney, Australia. They completed a purpose designed survey and six other validated instruments which assessed FCR, psychological functioning, quality of life, demographic, social and clinical variables. RESULTS Of the 364 respondents, approximately 11% of the sample lived with severe FCR while only 5% of subjects reported having no FCR. Variables significantly associated with higher FCR included unemployment, a shorter time (years) post-transplant, not attending to health screening (PAP smear), a secondary diagnosis of skin cancer, younger age, referral to a psychiatrist and taking psychotropic medication. Higher psychological distress (depression, anxiety, stress) and lower quality of life made a significant contribution to the prediction of FCR. CONCLUSIONS Post HSCT follow-up care should include an assessment and discussion regarding FCR to balance both realistic and unrealistic cancer recurrence risks. Managing FCR is one of the most ubiquitous unmet needs of survivors of haematological disease and it is important that HSCT nurses are both aware of the fear, and are equipped with knowledge on how to help patients navigate it with realistic expectations.
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Affiliation(s)
- Lisa Brice
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Gemma McErlean
- 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, NSW, Australia.
| | - Caroline Donovan
- School of Applied Psychology, Griffith University, QLD, Australia
| | - Caley Tapp
- School of Applied Psychology, Griffith University, QLD, Australia
| | - Nicole Gilroy
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Sydney, NSW, Australia
| | - Matt Greenwood
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia; Northern Blood Research Centre, Kolling Institute, University of Sydney, NSW, Australia
| | - Stephen R Larsen
- Institute 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
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Louisa Brown
- Calvary 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
| | - Jeff Tan
- Department of Haematology, St Vincents Hospital, Sydney, NSW, Australia
| | - Christopher Ward
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia; Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia; Westmead Breast Cancer Institute, Sydney, NSW, Australia
| | - Ian Kerridge
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia; Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia; Westmead Breast Cancer Institute, Sydney, NSW, Australia
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6
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Dyer G, Gilroy N, Brice L, Kabir M, Gottlieb D, Huang G, Hogg M, Brown L, Greenwood M, Larsen SR, Moore J, Hertzberg M, Tan J, Ward C, Kerridge I. A survey of infectious diseases and vaccination uptake in long-term hematopoietic stem cell transplant survivors in Australia. Transpl Infect Dis 2019; 21:e13043. [PMID: 30585673 DOI: 10.1111/tid.13043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/17/2018] [Accepted: 12/09/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND This cross-sectional survey aimed to establish the prevalence of infectious diseases and vaccination uptake in long-term allogeneic hematopoietic stem cell transplants (HSCT) survivors in New South Wales, in order to reduce long-term post-HSCT morbidity and mortality and enhance long-term care. PATIENTS AND METHODS Hematopoietic stem cell transplants survivors aged over 18 years and transplanted between 2000-2012 in New South Wales (NSW) were eligible to participate. Survivors self-completed the Sydney Post BMT Study survey, FACT-BMT (V4), Chronic Graft versus Host Disease (cGVHD) Activity Assessment Self Report, Lee Chronic GvHD Symptom Scale, DASS21, Post Traumatic Growth Inventory, and the Fear of Recurrence Scale. RESULTS Of the 583 HSCT survivors contacted, 441 (78%) completed the survey. Respondents included 250 (57%) males and median age was 54 years (range 19-79 years). The median age at the time of transplant was 49 years (Range: 17-71), the median time since HSCT was 5 years (Range: 1-14) and 69% had cGVHD. Collectively, 41.7% of survivors reported a vaccine preventable disease (VPD) with the most common being influenza-like-illness (38.4%), varicella zoster/shingles (27.9%), pap smear abnormalities (9.8%), pneumococcal disease (5.1%), and varicella zoster (chicken pox) (4.6%). Only 31.8% had received the full post-HSCT vaccination schedule, and the majority (69.8%) of these had received the vaccines via their General Practitioner. cGVHD was not found to be a significant factor on multivariate analysis for those who were vaccinated. There was a trend toward lower vaccination rates in patients in a lower income strata. CONCLUSIONS Vaccinating post-HSCT survivors to prevent infections and their consequences have an established role in post-HSCT care. Improving rates of post-HSCT vaccination should be a major priority for BMT units.
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Affiliation(s)
- Gemma Dyer
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, New South Wales, Australia.,Faculty of Medicine, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Nicole Gilroy
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, New South Wales, Australia
| | - Lisa Brice
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Sydney, New South Wales, Australia
| | - David Gottlieb
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Gillian Huang
- Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Megan Hogg
- Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Louisa Brown
- Department of Haematology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Matt Greenwood
- Faculty of Medicine, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, New South Wales, Australia
| | - Stephen R Larsen
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - John Moore
- Department of Haematology, St Vincents Hospital, Sydney, New South Wales, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Jeff Tan
- Department of Haematology, St Vincents Hospital, Sydney, New South Wales, Australia
| | - Christopher Ward
- Faculty of Medicine, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, New South Wales, Australia
| | - Ian Kerridge
- Faculty of Medicine, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, New South Wales, Australia
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7
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Dyer G, Brice L, Schifter M, Gilroy N, Kabir M, Hertzberg M, Greenwood M, Larsen SR, Moore J, Gottlieb D, Huang G, Hogg M, Brown L, Tan J, Ward C, Kerridge I. Oral health and dental morbidity in long-term allogeneic blood and marrow transplant survivors in Australia. Aust Dent J 2018; 63:312-319. [PMID: 29878377 DOI: 10.1111/adj.12627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oral and dental disease is a major cause of long-term morbidity following allogeneic blood and marrow transplantation (Allo-BMT). This study aimed to describe the extent and range of oral and dental complications in BMT recipients and to identify gaps in service provision provided to this high-risk group. METHODS Participants were Allo-BMT recipients, aged >18 years, and received transplants between 2000 and 2012 in NSW. They completed seven surveys, the purpose-designed Sydney Post-BMT Study survey and six other validated instruments. RESULTS Of 441 respondents, many reported dry mouth (45.1%), dental caries (36.7%), mouth ulcers (35.3%), oral GVHD (35.1%), gingivitis (16.2%), tooth abscess (6.1%) and oral cancer (1.5%). Regular dental visits were reported by 66.2% of survivors. Middle-high income, older age and geographic location showed a positive association with regular dental visits. Of those who did not visit the dentist regularly, 37% stated they did not feel it necessary, 36% reported cost and 20% stated it was not advised by the treating team. CONCLUSION Despite oral complications commonly occurring after Allo-BMT, many survivors receive inadequate dental care. These results emphasize the need for improved oral health education, the importance of regular dental checks and improvement in the delivery of dental health services for BMT survivors.
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Affiliation(s)
- G Dyer
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, New South Wales, Australia
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - L Brice
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - M Schifter
- Westmead Centre for Oral Health, Westmead Hospital, Sydney, New South Wales, Australia
- Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia
- Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia
| | - N Gilroy
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, New South Wales, Australia
| | - M Kabir
- Westmead Breast Cancer Institute, Sydney, New South Wales, Australia
| | - M Hertzberg
- Department of Haematology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - M Greenwood
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - S R Larsen
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - J Moore
- Department of Haematology, St Vincents Hospital, Sydney, New South Wales, Australia
| | - D Gottlieb
- Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia
| | - G Huang
- Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia
| | - M Hogg
- Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia
| | - L Brown
- Department of Haematology, Calvary Mater, Newcastle, New South Wales, Australia
| | - J Tan
- Department of Haematology, St Vincents Hospital, Sydney, New South Wales, Australia
| | - C Ward
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - I Kerridge
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
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8
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Dyer G, Brice L, Gilroy N, Kabir M, Hertzberg M, Greenwood M, Larsen SR, Moore J, Gottlieb D, Huang G, Hogg M, Brown L, Tan J, Ward C, Kerridge I. Changes to work status and household income of long-term allogeneic blood and marrow transplant survivors in New South Wales, Australia. Bone Marrow Transplant 2018; 53:926-931. [PMID: 29379170 DOI: 10.1038/s41409-018-0098-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/27/2017] [Accepted: 12/28/2017] [Indexed: 01/21/2023]
Affiliation(s)
- 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.
| | - 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
| | - Masura Kabir
- Westmead Breast Cancer Institute, Sydney, NSW, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Matt Greenwood
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Stephen R Larsen
- Institute 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
| | - Gillian Huang
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Megan Hogg
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Louisa Brown
- Department of Haematology, Calvary Mater, Newcastle, NSW, Australia
| | - Jeff Tan
- Department of Haematology, St Vincents Hospital, Sydney, NSW, Australia
| | - Christopher Ward
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Ian Kerridge
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
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Lindsay J, Kabir M, Gilroy N, Dyer G, Brice L, Moore J, Greenwood M, Hertzberg M, Gottlieb D, Larsen SR, Hogg M, Brown L, Huang G, Tan J, Ward C, Kerridge I. Epidemiology of complementary and alternative medicine therapy use in allogeneic hematopoietic stem cell transplant survivorship patients in Australia. Cancer Med 2016; 5:3606-3614. [PMID: 27790858 PMCID: PMC5224858 DOI: 10.1002/cam4.889] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 11/09/2022] Open
Abstract
In addition to prescribed conventional medicines, many allogeneic hematopoietic stem cell transplant (HSCT) survivors also use complementary and alternative medical therapies (CAM), however, the frequency and types of CAMs used by allogeneic HSCT survivors remain unclear. Study participants were adults who had undergone an allogeneic HSCT between 1st January 2000 and 31st December 2012. Participants completed a 402-item questionnaire regarding the use of CAM, medical complications, specialist referrals, medications and therapies, infections, vaccinations, cancer screening, lifestyle, and occupational issues and relationship status following stem cell transplantation. A total of 1475 allogeneic HSCT were performed in the study period. Of the 669 recipients known to be alive at study sampling, 583 were contactable and were sent study packs. Of 432 participants who returned the completed survey (66% of total eligible, 76% of those contacted), 239 (54.1%) HSCT survivors used at least one form of CAM. These included dietary modification (13.6%), vitamin therapy (30%), spiritual or mind-body therapy (17.2%), herbal supplements (13.5%), manipulative and body-based therapies (26%), Chinese medicine (3.5%), reiki (3%), and homeopathy (3%). These results definitively demonstrate that a large proportion of HSCT survivors are using one or more form of CAM therapy. Given the potential benefits demonstrated by small studies of specific CAM therapies in this patient group, as well as clearly documented therapies with no benefit or even toxicity, this result shows there is a large unmet need for additional studies to ascertain efficacy and safety of CAM therapies in this growing population.
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Affiliation(s)
- Julian Lindsay
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Masrura Kabir
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Nicole Gilroy
- Westmead Hospital, Sydney, New South Wales, Australia.,Cancer Institute NSW, Sydney, New South Wales, Australia
| | - Gemma Dyer
- Cancer Institute NSW, Sydney, New South Wales, Australia.,Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Brice
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - John Moore
- Department of Haematology, St Vincents Hospital, Sydney, New South Wales, Australia
| | - Matthew Greenwood
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.,Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | | | - Stephen R Larsen
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Megan Hogg
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Louisa Brown
- Department of Haematology, Calvary Mater Newcastle, Sydney, New South Wales, Australia
| | - Gillian Huang
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Jeff Tan
- Department of Haematology, St Vincents Hospital, Sydney, New South Wales, Australia
| | - Christopher Ward
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.,Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Ian Kerridge
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.,Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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Brice L, Gilroy N, Dyer G, Kabir M, Greenwood M, Larsen S, Moore J, Kwan J, Hertzberg M, Brown L, Hogg M, Huang G, Tan J, Ward C, Gottlieb D, Kerridge I. Haematopoietic stem cell transplantation survivorship and quality of life: is it a small world after all? Support Care Cancer 2016; 25:421-427. [PMID: 27699502 DOI: 10.1007/s00520-016-3418-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 09/19/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this qualitative study was to gain a rich understanding of the impact that haematopoietic stem cell transplantation (HSCT) has on long-term survivor's quality of life (QoL). METHOD Participants included 441 survivors who had undergone HSCT for a malignant or non-malignant disease. Data were obtained by a questionnaire positing a single open-ended question asking respondents to list the three issues of greatest importance to their QoL in survivorship. Responses were analysed and organised into QoL themes and subthemes. RESULTS Major themes identified included the following: the failing body and diminished physical effectiveness, the changed mind, the loss of social connectedness, the loss of the functional self and the patient for life. Each of these themes manifests different ways in which HSCT survivor's world and opportunities had diminished compared to the unhindered and expansive life that they enjoyed prior to the onset of disease and subsequent HSCT. CONCLUSIONS HSCT has a profound and pervasive impact on the life of survivors-reducing their horizons and shrinking various parts of their worlds. While HSCT survivors can describe the ways in which their life has changed, many of their fears, anxieties, regrets and concerns are existential in nature and are ill-defined-making it exceeding unlikely that they would be adequately captured by standard psychometric measures of QoL post HSCT.
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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
| | - Masura Kabir
- Westmead Breast Cancer Institute, Sydney, NSW, Australia
| | - Matt Greenwood
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Stephen Larsen
- Department of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - John Moore
- Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia
| | - John Kwan
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Louisa Brown
- Calvary 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
| | - Jeff Tan
- Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Christopher Ward
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - David Gottlieb
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Ian Kerridge
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
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Smith J, Poon C, Gilroy N, Kabir M, Brice L, Dyer G, Hogg M, Greenwood M, Moore J, Hertzberg M, Brown L, Tan J, Huang G, Kwan J, Larsen S, Ward C, Kerridge I. Nutritional issues and body weight in long-term survivors of allogeneic blood and marrow transplant (BMT) in NSW Australia. Support Care Cancer 2016; 25:137-144. [PMID: 27585809 DOI: 10.1007/s00520-016-3398-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 08/23/2016] [Indexed: 01/01/2023]
Abstract
PURPOSE The aims of this study were to describe the long-term nutrition, body weight and body image issues facing survivors of Allogeneic Blood and Marrow Transplant (BMT) and their impact on quality of life. It also describes survivors' perception of enteral feeding during BMT. METHODS Four hundred and forty-one survivors who had undergone a BMT in NSW, Australia between 2000 and 2012 (n = 441/583) completed the Sydney Post BMT Study Survey (SPBS). RESULTS Forty-five percent of survivors less than 2-year post-transplant reported a dry mouth, 36 % reported mouth ulcers and 19 % had diarrhoea. This was consistent across all survivor groups, regardless of time since transplant. Patients with one or more gastrointestinal (GI) symptoms had significantly lower quality of life scores. There was a significant difference in quality of life scores when comparing those with no GI symptoms to those with one or more symptoms (P = <0.0001). Quality of life was significantly higher in those who once again enjoyed mealtimes (P < 0.0001). Males were more likely to be satisfied with their body weight compared to females (P = 0.009). The median body mass index (BMI) for all patients reporting body weight satisfaction was significantly lower (BMI 23.5) than those reporting dissatisfaction (BMI 27.5) (P = <0.0001). Survivors who had a normal BMI had significantly higher rates of body weight satisfaction compared to underweight, overweight and obese survivors (P = <0.0001). Those survivors who were overweight or obese were significantly more likely to be diabetic (P = 0.008). CONCLUSION This study revealed an important relationship between gastrointestinal symptoms, body weight and body image and survivor's quality of life. It provides further support for the importance of nutrition therapy post-BMT.
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Affiliation(s)
- Jennifer Smith
- Nutrition Services, Royal North Shore Hospital, Building 30, Level 2, Pacific Highway, St Leonards, NSW, 2065, Australia.
| | - Christine Poon
- Nutrition Services, Royal North Shore Hospital, Building 30, Level 2, Pacific Highway, St Leonards, NSW, 2065, Australia
| | - Nicole Gilroy
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Sydney, NSW, Australia
| | - Lisa Brice
- Department of Haematology, Royal North Shore Hospital, 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
| | - Megan Hogg
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Matthew Greenwood
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
- Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - John Moore
- Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Louisa Brown
- Department of Haematology, Calvary Mater Newcastle, Sydney, NSW, Australia
| | - Jeff Tan
- Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Gillian Huang
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - John Kwan
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Stephen Larsen
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Christopher Ward
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
- Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Ian Kerridge
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
- Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
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12
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Dyer G, Larsen SR, Gilroy N, Brice L, Greenwood M, Hertzberg M, Kabir M, Brown L, Hogg M, Huang G, Moore J, Gottlieb D, Kwan J, Tan J, Ward C, Kerridge I. Adherence to cancer screening guidelines in Australian survivors of allogeneic blood and marrow transplantation (BMT). Cancer Med 2016; 5:1702-16. [PMID: 27108674 PMCID: PMC4944898 DOI: 10.1002/cam4.729] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/14/2016] [Accepted: 03/15/2016] [Indexed: 11/07/2022] Open
Abstract
Allogeneic Blood and Marrow Transplant (BMT) survivors are at high risk of secondary cancers. Although current guidelines endorse survivors following Country-specific general population screening recommendations to mitigate this risk, little is known about cancer screening adherence in Australian BMT survivors. We conducted a cross-sectional survey of 441 BMT survivors who were >1 year post transplant, to explore rates of screening for secondary cancers and to identify barriers to cancer screening recommendations. Survey instruments included the Sydney Post-BMT Survey, FACT-BMT, DASS 21, The Chronic Graft versus Host Disease (GVHD) Activity Assessment-Patient Self-Report (Form B), the Lee Chronic GVHD Symptom Scale, Fear of Cancer Recurrence Scale, and The Post Traumatic Growth Inventory. Fifty-seven percent of respondents were male, median age 54 years, and 40% were >6 years post-BMT. Rates of cancer screening adherence were as follows: cervical 63.4%, breast 53.3%, skin 52.4%, and bowel 32.3%. Older BMT survivors and those >2 years post transplant were more likely to undergo cancer screening. Improved quality of life was associated with screening for skin, breast, and cervical cancer. Fear of cancer recurrence negatively impacted on cervical screening. For those who had not undergone screening, the majority reported not being advised to do so by their treatment team. This study is the largest and most comprehensive to date exploring cancer screening adherence in BMT survivors in Australia. These data provide the basis for health service reform to better meet the needs of BMT survivors and provide evidence to support counseling and education of both patients and professionals.
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Affiliation(s)
- Gemma Dyer
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Stephen R Larsen
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Nicole Gilroy
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Lisa Brice
- Department of Haematology, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Matt Greenwood
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal North Shore Hospital, St. Leonards, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Camperdown, NSW, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Westmead, NSW, Australia
| | - Louisa Brown
- Department of Haematology, Calvary Mater Newcastle, Newcastle, NSW, Australia
| | - Megan Hogg
- Department of Haematoloy, Westmead Hospital, Sydney, NSW, Australia
| | - Gillian Huang
- Department of Haematoloy, Westmead Hospital, Sydney, NSW, Australia
| | - John Moore
- Department of Haematology, St Vincents Hospital, Sydney, NSW, Australia
| | - David Gottlieb
- Department of Haematoloy, Westmead Hospital, Sydney, NSW, Australia
| | - John Kwan
- Department of Haematoloy, Westmead Hospital, Sydney, NSW, Australia
| | - Jeff Tan
- Department of Haematology, St Vincents Hospital, Sydney, NSW, Australia
| | - Christopher Ward
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal North Shore Hospital, St. Leonards, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Ian Kerridge
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal North Shore Hospital, St. Leonards, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
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13
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Dyer G, Gilroy N, Brown L, Hogg M, Brice L, Kabir M, Greenwood M, Larsen SR, Moore J, Hertzberg M, Kwan J, Huang G, Tan J, Ward C, Kerridge I. What They Want: Inclusion of Blood and Marrow Transplantation Survivor Preference in the Development of Models of Care for Long-Term Health in Sydney, Australia. Biol Blood Marrow Transplant 2015; 22:731-743. [PMID: 26746819 DOI: 10.1016/j.bbmt.2015.12.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 12/17/2015] [Indexed: 12/19/2022]
Abstract
Four hundred forty-one adult allogeneic blood and marrow transplantation (BMT) survivors participated in a cross-sectional survey to assess long-term follow-up (LTFU) model of care preference. Survey instruments included the Sydney Post BMT Survey, Functional Assessment of Cancer Therapy-BMT, Depression Anxiety Stress Scales 21, the Chronic GVHD Activity Assessment-Patient Self Report (Form B), the Lee Chronic GVHD Symptom Scale and the Post-Traumatic Growth Inventory. We found most BMT survivors (74%) would prefer LTFU with their transplantation physicians alone or in combination with transplantation center-linked services (satellite clinics or telemedicine) Over one-quarter indicated a preference for receiving comprehensive post-transplantation care in a "satellite" clinic staffed by their BMT team situated closer to their place of residence, with higher income, higher educational level, and sexual morbidity being significant social factors influencing this preference. Regular exercise was reported less often in those who preferred telemedicine, which may reflect reduced mobility. The factor most strongly associated with a preference for transplantation center follow-up was the severity of chronic graft-versus-host disease. Full- and part-time work were negatively associated with transplantation center follow-up, possibly implying decreased dependency on the center and some return to normalcy. This study is the first to explore the preferences of BMT survivors for long-term post-transplantation care. These data provides the basis for LTFU model of care development and health service reform consistent with the preferences of BMT survivors.
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Affiliation(s)
- Gemma Dyer
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia; Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, New South Wales, Australia.
| | - Nicole Gilroy
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, New South Wales, Australia
| | - Louisa Brown
- Department of Haematology, Calvary Mater Newcastle, NSW, Australia
| | - Megan Hogg
- Department of Haematoloy, Westmead Hospital, Sydney, New South Wales, Australia
| | - Lisa Brice
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Sydney, New South Wales, Australia
| | - Matt Greenwood
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia; Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia; Northern Blood Research Centre, Kolling Institute, University of Sydney, New South Wales, Australia
| | - Stephen R Larsen
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - John Moore
- Department of Haematology, St. Vincents Hospital, Sydney, New South Wales, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - John Kwan
- Department of Haematoloy, Westmead Hospital, Sydney, New South Wales, Australia
| | - Gillian Huang
- Department of Haematoloy, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jeff Tan
- Department of Haematology, St. Vincents Hospital, Sydney, New South Wales, Australia
| | - Christopher Ward
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia; Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia; Northern Blood Research Centre, Kolling Institute, University of Sydney, New South Wales, Australia
| | - Ian Kerridge
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia; Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia; Northern Blood Research Centre, Kolling Institute, University of Sydney, New South Wales, Australia
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14
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Dyer G, Gilroy N, Bradford J, Brice L, Kabir M, Greenwood M, Larsen SR, Moore J, Hertzberg M, Kwan J, Brown L, Hogg M, Huang G, Tan J, Ward C, Kerridge I. A survey of fertility and sexual health following allogeneic haematopoietic stem cell transplantation in New South Wales, Australia. Br J Haematol 2015; 172:592-601. [PMID: 26847746 DOI: 10.1111/bjh.13872] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/19/2015] [Indexed: 12/23/2022]
Abstract
Four hundred and twenty-one adult allogeneic haematopoietic stem cell transplant (HSCT) survivors participated in a cross-sectional study to assess sexual dysfunction and infertility post-transplant. Survey instruments included the Sydney Post-Blood and Marrow Transplant (BMT) Survey, Functional Assessment of Cancer Treatment (FACT) - BMT, the Depression, Anxiety, Stress Scales (DASS 21), the Chronic Graft-versus-Host Disease (cGVHD) Activity Assessment- Patient Self Report (Form B), the Lee cGVHD Symptom Scale and The Post-Traumatic Growth Inventory. Most HSCT survivors reported sexual difficulties (51% of males; 66% of females). Men reported erectile dysfunction (79%) and decreased libido (61·6%) and women reported loss of libido (83%), painful intercourse (73%) and less enjoyment of sex (68%). Women also commonly reported vaginal dryness (73%), vaginal narrowing (34%) and vaginal irritation (26%). Woman had much higher rates of genital cGvHD than men (22% vs. 5%). Age and cGVHD were significantly associated with sexual dysfunction. Few survivors had children following transplant (3·3%). However, for those of reproductive age at HSCT, 22% reported trying to conceive, with 10·3% reporting success. This study is the largest to date exploring sexual function in survivors of allo-HSCT. This data provides the basis for health service reform to better meet the needs of HSCT survivors, including evidence to support counselling and education both pre- and post-transplant.
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Affiliation(s)
- Gemma Dyer
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Nicole Gilroy
- Blood and Marrow Transplant Network, New South Wales Agency for Clinical Innovation, Sydney, NSW, Australia
| | - Jennifer Bradford
- Department of Obstetrics & Gynaecology, Westmead Hospital, Sydney, NSW, Australia
| | - Lisa Brice
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Sydney, NSW, Australia
| | - Matt Greenwood
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Stephen R Larsen
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - John Moore
- Department of Haematology, St Vincent Hospital, Sydney, NSW, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - John Kwan
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Louisa Brown
- Department of Haematology, Newcastle Mater Hospital, Sydney, NSW, Australia
| | - Megan Hogg
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Gillian Huang
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Jeff Tan
- Department of Haematology, St Vincent Hospital, Sydney, NSW, Australia
| | - Christopher Ward
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Ian Kerridge
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Blood Research Centre, Kolling Institute, University of Sydney, Sydney, NSW, Australia
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Tilford S, Clifton J, Brice L, Wiggins-Smith J, Penrose L, Farooqi N. Influence of sex education on condom knowledge and use proficiency among Texas college students. Contraception 2013. [DOI: 10.1016/j.contraception.2013.05.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Brice L, Weiss R, Wei Y, Satwani P, Bhatia M, George D, Garvin J, Morris E, Harrison L, Cairo MS, Sands SA. Health-related quality of life (HRQoL): the impact of medical and demographic variables upon pediatric recipients of hematopoietic stem cell transplantation. Pediatr Blood Cancer 2011; 57:1179-85. [PMID: 21520396 DOI: 10.1002/pbc.23133] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 02/24/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND The trajectory of Heath-Related Quality of Life (HRQoL) in pediatric recipients who have undergone hematopoietic stem cell transplantation (HSCT), as well as the demographic and medical factors that predict HRQoL, has lagged behind the adult research. METHODS A prospective longitudinal study of HRQoL in pediatric HSCT recipients was conducted with 95 patients at the Columbia University Medical Center between 2002 and 2009. Both children and parents completed the PedsQL 4.0 prior to HSCT and at days 100, 180, and 365-post-HSCT. RESULTS The majority of patients and their parents reported linear improvements in HRQoL in the first year post-transplant; however, a portion of patients were in the at-risk group at each time point. Latent growth modeling was utilized to examine demographic and medical factors that predicted initial HRQoL and its trajectory. Older age at transplant significant predicted lowered HRQoL at baseline for self- and parent-report. Female gender significantly impacted lowered self-reported physical HRQoL over time. Ethnicity was a significant predictor of HRQoL at baseline and over time for self- and parent-report, with African-American children reporting the highest HRQoL; whereas, the worst decline in psychosocial HRQoL was often reported by parents and children of Asian descent. CONCLUSION This research identifies the significant impact of ethnicity upon HRQoL following pediatric HSCT. It is likely that an individual's pre-morbid experiences and expectations, particularly with regard to culture, behaviors, and values, influence the parent and child's perceptions and expectations of the HSCT process.
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Affiliation(s)
- Lisa Brice
- Oncology Unit, The Children's Hospital, Westmead, North South Wales, Australia
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Brice L. As a registered nurse are you truly a patient advocate? ANNA J 1999; 26:273-4. [PMID: 10418358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- L Brice
- Oregon Health Sciences University, Portland, USA
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