Acute health-related quality of life in children undergoing stem cell transplant: II. Medical and demographic determinants

Abstract

Summary:Medical and demographic variables were examined as predictors of acute health-related quality of life (HRQL), specifically, somatic distress, mood disturbance and activity levels, during the period of bone marrow transplant (BMT) hospitalization, and the transition phase in the months following hospital discharge. The responses of 153 children undergoing BMT were assessed by both parent report and patient self-report in a prospective longitudinal design. Type of transplant, diagnosis, age, gender, and socio-economic status (SES) were examined as predictor variables of patient outcome. Type of transplant, patient age, and SES emerged as significant determinants of patient response. Children undergoing unrelated donor (MUD) transplants experiencing the highest levels of distress, followed by those undergoing matched-sibling BMT, while those undergoing autologous transplant experienced the lowest levels of distress. Younger patients experienced lower levels of distress and better HRQL than older children and adolescents. Although patients from different SES backgrounds appeared very similar at the time of hospital admission, those from lower SES backgrounds demonstrated greater distress and disturbance in HRQL subsequently, and throughout the first 6 months post BMT. These findings help to target specific subgroups of patients that may be in greater need of preventive interventions or more aggressive supportive care. Bone Marrow Transplantation (2002) 29, 435-442. DOI: 10.1038/sj/bmt/1703376 Keywords: bone marrow transplant; children; hospitalization; distress; mood disturbance; quality of life It has been suggested that all of the necessary research regarding patient psychosocial and quality of life outcomes following bone marrow or stem cell transplantation (BMT)

Pediatric allo-SCT for malignant and non-malignant diseases: impact on health-related quality of life outcomes

“…[25][26][27] Although this is in contrast to other studies that found higher levels of distress before and post-HSCT, our findings support the notion that pre-transplant psychological state may predict post transplant behavior. [18][19][20][21][22][23][24] Our high psychosocial scores may reflect the level of emotional and social support received from their own family and friends as well as supportive relationships made with other children receiving care, clinical staff and providers. However, it is also possible that change may be very subtle and not easily detected or the PedsQL 4.0 was not sufficiently sensitive to detect emotional or social functioning perturbations and results should be interpreted with caution.…”

“…Some studies support that patients with higher levels of distress pretransplant tend to experience higher levels of distress following stem cell infusion, suggesting that pre-HSCT psychological state may predict post-HSCT distress and functioning. [18][19][20][21][22][23][24] Others claim that pediatric survivors have reasonable adjustment and satisfactory HRQOL the first 2 years post-HSCT, [25][26][27] whereas further studies suggest that pediatric HSCT recipients are at risk for developing long-term emotional or social problems. 28,29 Based on limited prospective longitudinal studies, it is difficult for investigators to accurately identify decrements to HRQOL.…”

Health-related quality of life in survivors of BMT for paediatric malignancy: a systematic review of the literature

“…Demographic variables. Younger children (o6 years) showed less somatic distress, and better HRQL than older children, 19,21 but those o3 years were at greater risk for later cognitive problems. 17 In contrast, no associations between age at transplant 16,22,24,25 or gender 16,18 and HRQL were reported.…”

“…We refer to the article most relevant to psychosocial outcomes for the purpose of this review. Studies were conducted in the US, 7,[16][17][18][19][20][21] Sweden, [22][23][24] Canada, 25 Netherlands, 26 Spain, 27 Austria 28 and France. 29 All but three 21,28,29 were single centre studies.…”

Secondary malignancies and quality of life after stem cell transplantation

“…IQ scores remained stable during the first year post transplant. 30 In a similar study performed by Barrera et al, from Toronto, 26 children who underwent a BMT and their mothers completed questionnaires at pre-and 6 months post transplant. They also found that QOL had improved 6 months post transplant and emphasized that the pre-SCT levels of family cohesion and child adaptive functioning appeared to be important in QOL and behavioral adjustment.…”