Economic survivorship stress is associated with poor health‐related quality of life among distressed survivors of hematopoietic stem cell transplantation

Abstract

Objective Hematopoietic stem cell transplantation (HSCT) is a demanding cancer treatment associated with enduring physical and psychological complications. Survivors' well-being may be further compromised by exposure to chronic stressors common to this population, including difficulties arising from costly medical care, changes in employment status, and health insurance coverage. Thus, we hypothesized that financial, employment, and insurance stressors (collectively referred to as economic survivorship stressors) would be associated with poorer health-related quality of life (HRQOL) among HSCT survivors. Methods Survivors (n=181; M=640 days post-transplant) completed measures of study variables through mailed questionnaires and telephone interviews. Hierarchical regression analyses were conducted to test the hypothesized associations between economic survivorship stressors and HRQOL, and to examine whether social and situational factors interact with survivors' stress perceptions to predict HRQOL. Results Greater financial and employment stress were associated with poorer functioning across multiple HRQOL domains, even after controlling for the effects of possible confounding sociodemographic and medical variables. Insurance stress was not associated with HRQOL. Some associations were moderated by situational factors including timing of the current financial crisis and portion of the transplant paid for by health insurance. Conclusions HSCT survivors can face serious economic challenges during recovery. Results suggest the value of viewing these challenges as chronic stressors capable of reducing survivors' mental and physical well-being. Identifying resources and skills that help survivors cope with these demands is an important goal for clinicians and researchers.

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

“…The most common graft type in the present study was allogeneic (69.44%), more specifically, allogeneic from family donors, with a percentage of 41.67%. Similar data were found in a North American study in which allogeneic HSCTs accounted for 53.6% (18) . However, it differs from the HSCT characteristics performed in 2014 in Brazil, where the number of autologous HSCTs (1,275) was higher than allogeneic HSCTs (738) (2) .…”

Occupational status among adult survivors following allo-SCT

“…7,14 Not working at all was related to a poorer general health among SCT patients, which is also seen in previous studies. 14,22,29 However, other factors-being older, being a woman and having been born abroad-were associated with working part-time.…”

“…16,24 Studies from the United States show that about one-third of SCT survivors have concerns about keeping their job, 22 worries that they will need to take a disability pension or a paid leave of absence, which leads to an impaired quality of life. 29 Many have financial problems, 7,20 and 5 years post SCT, survivors rate their financial situation worse than the controls, 35 whereas by 10 years post SCT there is no such difference. 8 In general, multi-morbidity and self-rated health are not necessarily predictors of sickness absence or disability pension.…”

A Pound of Cure Requires An Ounce (or More) of Prevention: Survivorship and Complications of Therapy for Hematologic Malignancies

“…Hypertension, dyslipidemia, and diabetes are common, necessitating periodic CV assessments [120,123]. Non-medical toxicities of alloHCT include financial stress, economic disability, and caregiver burnout [124][125][126]. With these points in mind, comprehensive long-term follow-up units aimed specifically at alloHCT survivors have shown evidence of efficacy [119•].…”