Application of the NCCN-distress thermometer in pediatric patients during autologous and allogeneic HSCT and relationship to blood parameters of the stress axis

Abstract

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.