The psychosocial impact of bone marrow transplantation: a review of the literature

Abstract

Summary:Bone marrow transplant (BMT) is a procedure used for the treatment of a variety of cancers and malignant diseases. Recovery from this intensive process requires a long-term course, often accompanied by acute morbidity which includes various distressing physical symptoms. Recent literature has begun to explore the impact of this procedure on quality of life and psychosocial issues. While survivorship is often associated with a highly rated global quality of life, recovery from BMT is accompanied by several psychosocial difficulties which negatively impact patients. Fatigue is a common complaint, often hindering recipients for several years following their transplant. As well, reports of psychological distress, psychiatric symptoms, and/or mood disturbances such as anxiety or depression are not uncommon. Many patients also indicate interruption of sexual activity and increased sexual difficulty for several months following BMT. While some investigators have begun to examine hormone replacement therapy (HRT) as a treatment option for reducing sexual dysfunction, there is a general paucity of literature evaluating interventions for BMT survivors. This article reviews the literature examining various quality of life aspects including fatigue, psychosocial difficulties, and sexual functioning of patients during recovery from BMT. Limitations of past research are discussed and directions for future research suggested. Keywords: bone marrow transplantation; review; fatigue; sexual functioning; psychological distress Bone marrow transplantation (BMT) is an innovative procedure developed for treating malignant disease. The most common indications for BMT are Hodgkin's disease, nonHodgkin's lymphoma, leukemia, metastatic breast cancer, and its use is increased as treatment technology improves, particularly with respect to reduced morbidity and increased life expectancy. Two types of BMT are currently most Correspondence: CS Neitzert,

Pathways for psychosocial care of cancer survivors

“…40,38 Problems with sexual functioning have also been reported by 26 -82% BMT survivors. 31,[15][16][17][18] Two years after completion of active treatment, 42% of BMT survivors reported decreased sexual desire, 17% complained of decreased sexual functioning, 25% reported inability to function sexually, and 33% reported experiencing difficulties with their partners over issues of sexuality. Male BMT survivors frequently report difficulties with achieving erection and ejaculation; whereas female BMT survivors report vasomotor difficulties, pain during intercourse, vaginal dryness, and hot flashes.…”

“…23,[72][73] A substantial proportion (33-54%) of BMT survivors experience significant psychological and emotional distress, such as mood disturbance, tension, and depression after completion of treatment. 16,18,74 High prevalence rates (45-65%) of anxiety and depression have been reported by breast cancer, BMT, colorectal, prostate, and lung cancer survivors. 23 Long-term survivors of pediatric leukemia, Hodgkin disease, and non-Hodgkin lymphoma were more likely to report symptoms of depression and somatic distress than their sibling controls, and having high dose chemotherapy contributed to the risk of developing these symptoms.…”

“…56 Energy deficits and sleep disturbance also remain problematic for BMT survivors long after transplantation, 57 with fatigue rated as one of the most problematic concerns that negatively impacts their spirits and quality of life. 15,18,58 Possible biological basis for cluster symptoms. Recent research findings suggest that internal release of inflammatory cytokines in response to illness or treatment may account for flu-like symptoms or illness behavior, which often include a cluster of symptoms, sad mood, fatigue, weakness, diminished stamina, sleep disturbance, poor concentration, and cognitive difficulties.…”

“…Conversely, both Hodgkin and leukemia survivors 14 and bone marrow transplant patients are apt to have more distress, especially in the presence of physical sequelae and disability. [15][16][17][18][19][20][21][22] Although most cancer survivors are able to adjust well to their cancer experience, research suggests that distress may vary from negligible in some groups to as much as 30 -40% in others. 21 Psychosocial concerns of cancer survivors relate to a wide range of issues: possible late effects of treatment, neuropsychological and cognitive sequelae, changes in body image, psychological reaction to having had a life-threatening illness, and complications accompanying survivors' reentry into preillness social, occupational, and family roles.…”

Pre-transplantation physical and mental functioning is strongly associated with self-reported recovery from stem cell transplantation

“…Fatigue is a commonly reported symptom among survivors. 2 Psychological difficulties are also often present. Depression 3 and anxiety 4 are common, including a 5% incidence of post-traumatic stress disorder.…”