Psychosocial and financial issues after hematopoietic cell transplantation

Abstract

With improvement in survival after hematopoietic cell transplantation (HCT), it has become important to focus on survivors' psychosocial issues in order to provide patient-centered care across the transplant continuum. The goals of this article are to describe updates in the literature on certain psychosocial domains (emotional/mental health and social/financial) in HCT survivors, offer a brief overview of the status of the screening and management of these complications, and identify opportunities for future practice and research. An evidence-based approach to psychosocial care can be broken down as primary (promoting health, raising awareness, and addressing risk factors), secondary (screening and directing early pharmacological and nonpharmacological interventions), and tertiary (rehabilitating, limiting disability, and improving quality of life) prevention. Implementing such an approach requires close coordination between multiple stakeholders, including transplant center staff, referring hematologist/oncologists, and other subspecialists in areas such as palliative medicine or psychiatry. Innovative models of care that leverage technology can bring these stakeholders together to fulfill unmet needs in this area by addressing barriers in the delivery of psychosocial care.

Hematopoietic Stem Cell Transplantation Impact on Patients’ Perceived Quality of Life: A Longitudinal Study

“…Additionally, other complications may arise, including pulmonary toxicity, hepatobiliary toxicity, heart disease, secondary malignant tumors, myelodysplasia/leukemia secondary to treatment, and secondary solid tumors [ 5 , 15 , 16 ]. Psychological effects, such as fear, anguish, and social isolation, although not necessarily manifesting physically, significantly impact patients socially and emotionally, disrupting their QoL and, at times, resulting in disabling consequences [ 14 , 17 , 18 ].…”

Assessing and Preparing Patients for Hematopoietic Stem Cell Transplant in Canada: An Environmental Scan of Psychosocial Care

“…The most frequent unmet needs for HCT patients are psychosocial, including emotional, cognitive, social, and financial [ 7 , 8 ]. Patients and caregivers can experience psychological morbidity from the transplant process, including depression, posttraumatic stress disorder, sleep disorders, sexual dysfunction, and diminished quality of life.…”

“…Quality psychosocial screening may identify risk factors early and facilitate a referral to appropriate services, such as psychology, social work, or psychiatry, to bolster psychosocial outcomes throughout the transplant process. A description of psychosocial clinicians and roles in supporting patients and caregivers through HCT can be found in Buchbinder and Khera’s manuscript [ 8 ].…”

“…Screening and referral practices that consider psychosocial risk factors and the need for additional professional supports have the potential to improve post-transplant psychosocial morbidity and survival for patients and caregivers [ 6 ]. Previous literature recognizes that many centres evaluate pre-transplant psychosocial factors to some extent [ 8 ]. However, little evidence exists to inform best practice: only one study surveyed the practices of psychosocial assessment across US centres [ 13 ].…”

Progress and Challenges in Survivorship After Acute Myeloid Leukemia in Adults

“…Up to 28% of patients with AML experienced posttraumatic stress disorder (PTSD) [ 52 ]. In HCT survivors, the rates of PTSD are between 12 and 30% [ 53 ]. In a study of 236 adult years after HSCT, psychological distress was present in 43% of allo-HCT survivors [ 54 ].…”