Long-term recovery after hematopoietic cell transplantation: predictors of quality-of-life concerns

Abstract

This prospective longitudinal study examined the quality of life (QOL) after hematopoietic cell transplantation (HCT) and identified risk factors of poor QOL in 312 adult autologous and allogeneic HCT patients. Physical, psychological, social, and spiritual well-being was assessed before HCT, 6 months, and 1, 2, and 3 years after HCT. For all HCT patients, physical QOL was stable from before to after HCT (P > .05); psychologic (P < .001), social (P < .001), and spiritual (P ‫؍‬ .03) QOL improved at 6 months. Study noncompleters (because of illness or death) had worse QOL. Allogeneic patients reported worse physical and psychologic wellbeing (P < .05). Older patients reported worse physical but better social wellbeing regardless of HCT type (P < .05). Two or more domains were affected by race/ethnicity, household income, and education in autologous patients, and by body mass index (BMI), decline in BMI, primary diagnosis, and chronic graftversus-host disease (GVHD) in allogeneic patients (P < .05). At 3 years, 74% of HCT patients were employed full or part time. Older autologous patients with lower pre-HCT income were less likely to work (P < .05); allogeneic patients with chronic GVHD were less likely to work (P ‫؍‬ .002). Multidisciplinary efforts to identify and support vulnerable subgroups after HCT need to be developed. (Blood. 2010;115: 2508-2519)

Occupational status among adult survivors following allo-SCT

“…Because of differences in study designs, as outlined in the Introduction section, it is difficult to compare studies. The RTW rate in the present study was 81%, when based only on those working before SCT, which is lower 18,19 or higher 21 than results from studies calculating the RTW rate in this way (Table 6). The proportion that reduces their working time after a cancer diagnosis varies, 31 and the same pattern is seen in the very few studies that report on part-time work among SCT survivors.…”

“…Third, only those who worked before SCT are included most often in these studies. 18,19,21 Finally, distinctions between those working full-or part-time are not considered. 7,16,17,19,21,22 The aim of this study was to elucidate occupational status and factors associated with work among people of working age who have undergone allo-SCT.…”

“…First, many studies combine results from auto-and allo-SCT patients, 18,19 which is not optimal because the quality-of-life scores 20 and RTW rates seems to differ significantly between those groups. 7,21 Second, occupational status before SCT is either unknown 8,14,17,[22][23][24] or gathered just before the SCT, 18,19,21 which is misleading because many patients at that time point are on sick leave because of consolidation treatments. Third, only those who worked before SCT are included most often in these studies.…”

Having a sibling as donor: Patients' experiences immediately before allogeneic hematopoietic stem cell transplantation

“…FACT-BMT was chosen as it is a frequently used and recommended instrument in studies of QoL in patients undergoing HSCT with demonstrated reliability and validity (Kopp et al, 2000;McQuellon et al, 1997). FACIT-Sp was used to assess the patients' spiritual well-being, since HSCT has been found to have an impact on this aspect of life (Andrykowski et al, 2005;Ferrell et al, 1992;Wong et al, 2010). FACT-BMT has been validated on HSCT patients (McQuellon et al, 1997) and the FACIT-Sp has been validated on people with cancer and other chronic illnesses (Peterman et al, 2002).…”

“…An additional reason for using a parametric test is that it can be combined with follow-up analyses using ANCOVA, which is not possible when a non-parametric test is used. Based on previous studies (Chiodi et al, 2000;Heinonen et al, 2001b;Wong et al, 2010) and our clinical experiences, the factors to be investigated in the study were chosen in advance, on the grounds that they may have a possible impact on QoL after HSCT.…”