Background. Hematopoietic stem cell transplantation (HSCT) is a curative treatment option for malignant and nonmalignant diseases that is highly distressing, especially for children. A valid assessment of pediatric patients’ distress that is independent from their language skills would be beneficial. Research regarding HSCT-specific self-reporting or rater-reporting instruments is scarce. Method. In this single-center prospective study, pediatric patients and young adolescents undergoing HSCT were screened for mental and somatic distress using PO-Bado (Basic Documentation for Psycho-Oncology) ratings from parents and medical caregivers on eight observations days before, during, and up to 200 days after HSCT. Additionally, the stress biomarkers cortisol and α-amylase were monitored on the same observation days. Results. A total of 39 pediatric and young adult patients with a median age of 9.3 years (range 0.5–19.0), with 18 females (46%) and 21 males, were enrolled. The perceptions of the patients’ somatic and mental distress of parents and medical caregivers of patients were significantly correlated (mental subscale ((r(276) = 0.31,
p
<
0.001
., 95% CI of the correlation: (0.20, 0.41)) and somatic subscale ((r(284) = 0.46,
p
<
0.001
., 95% CI of the correlation: 0.36, 0.54)). The time period between the days of transplantation until day +10 was rated as the most mentally and somatically distressing. Conclusions. While the somatic burden declined over time, the mental distress in the patients remained at a stable level, emphasizing the importance of further psychological and psycho-oncological support in these patients. The use of salivary α-amylase as a suitable distress detection marker in pediatric patients undergoing HSCT should be further investigated.
Purpose
Hematopoietic stem cell transplantations (HSCT) are extremely stressful procedures for pediatric patients. The activation of the Hypothalamic pituitary adrenocortical axis (HPA) can influence the immune system negatively and therefore the overall outcome. A screening instrument should be established to detect elevated stress levels.
Methods
In this prospective study, a distress thermometer with attached problem list was used in 40 pediatric patients and their parents. The patients were aged 10 to 18 years and received a HSCT. Furthermore, the patients' cortisol, thyroid stimulating hormone, free triiodothyronine and Thyroxine levels were measured regularly during the inpatient stay.
Results
After admission to the hospital, the stress levels of the pediatric patients and their parents increased and reached their maximum on the day of HSCT. The overall stress values of the parents were higher than those of the children, with a significant difference on the day of HSCT. The mean cortisol values of the pediatric patients also increased after admission, reaching significant elevated levels above the upper norm limit one week after HSCT and on discharge day. While the pediatric patients experienced mainly exhaustion, especially on the day of transplantation, their parents mainly felt worry and anxiety. Interestingly, the rate of worry among children increased in the posttransplant period and reached its maximum on the day of discharge.
Conclusions
These results confirm the need for early and continuous psycho-oncological intervention with the pediatric patients and their parents, especially up to the day of HSCT.
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