Coping and Modifiable Psychosocial Factors are Associated with Mood and Quality of Life in Patients with Chronic Graft-versus-Host Disease

Abstract

versus-host disease (GVHD) is one of most common complications following allogeneic hematopoietic cell transplantation (HCT) and the most significant contributor to morbidity and nonrelapse mortality. The physical burdens and psychosocial difficulties of these patients have not been described systematically. An exploration into the rates and correlates of mood and quality of life (QOL) in patients with chronic GVHD is necessary to develop a clinically relevant, evidence-based intervention to promote well-being. From July 2015 to July 2017, adult allogeneic HCT survivors with established moderate to severe chronic GVHD (N = 52) enrolled in a prospective, longitudinal study at a tertiary academic center. We examined the rates and correlates of depression and anxiety symptoms (Hospital Anxiety and Depression Scale) and explored whether constructs including coping strategies (Coping Inventory for Stressful Situations), symptom burden (Lee Symptom Assessment Scale), physical functioning (Human Activity Profile), and perceived social support (Medical Outcomes Study Social Support Survey) predicted QOL trajectory over time (Functional Assessment of Cancer TherapyÀBone Marrow Transplant) at the baseline, 3-month, and 6-month follow-up. Analyses adjusted for age, sex, chronic GVHD severity, and time since chronic GVHD diagnosis. At the baseline, 3-month, and 6-month follow-up, 32.7%, 31.1%, and 37.8% of patients reported clinically significant depression symptoms, and 30.8%, 20.0%, and 36.4% reported clinically elevated anxiety symptoms, respectively. Adjusting for covariates, greater use of negative emotion-oriented coping (b = 0.20, P = .002), less use of task-oriented coping (b = À0.10, P = .021), worse physical functioning (b = À0.07, P = .004), and higher symptom burden (b = 0.07, P = .002) were independently associated with depression symptoms at baseline. Greater use of negative emotion-oriented coping (b = 0.28, P < .001) and worse physical functioning (b = À0.05, P = .034) were independently associated with anxiety at baseline. Patients who used more negative emotion-oriented coping (b = À0.58, P = .035), had less task-oriented (b = 0.40, P = .028) and social diversion-oriented coping (b = 0.35, P = .039), and had higher symptom burden (b = À0.30, P = .001), worse physical functioning (b = 0.32, P < .001), and lower perceived social support (b = 6.47, P = .003) at baseline reported poorer QOL over time. The unmet physical and psychosocial needs of patients with chronic GVHD are substantial and warrant investigation into evidence-based interventions that may improve QOL and mood by targeting modifiable psychosocial constructs identified in this study.

Burden and Needs of Patients with Severe GvHD from the Supportive and Palliative Care Perspective—A Literature Review

“…We identified only one secondary analysis of a prospective cohort that distinguished between the different grades of cGvHD, examining psychological distress by depression and anxiety. El-Jawahri et al found that approximately 19.3% of 482 study participants with cGvHD suffered from depression, 22.8% had anxiety, and 14% showed symptoms of both, which was comparable with the findings of Jacobs et al [ 40 , 41 ]. They could not find any association between the incidence of depression and the severity of cGvHD (40% had severe cGvHD), but patients with self-reported symptoms of depression showed a higher symptom burden of their cGvHD.…”

“…Avoidance in the form of social diversion also allowed better coping with cGvHD and showed better QoL as compared to other coping strategies. In this trial with 52 study participants, 71.2% had moderate, and 28.8% had severe cGvHD [ 40 ].…”

“…Hamilton et al reported on the lower socioeconomic status of patients being associated with higher patient-reported severity of cGvHD and a reduced QoL, but they did not examine an association between severity of cGvHD, as objectified by the NIC global severity score, and socioeconomic status [ 49 ]. As for cGvHD without specification of severity, Jacobs et al identified patients with cGvHD and lower perceived social support to experience poorer QoL [ 40 ]. An overview of the main results of our review on QoL in patients with severe GvHD is presented in Table 2 .…”

Psychosocial aspects of hematopoietic stem cell transplantation

“…Despite prophylactic regimens, a significant number of recipients develop the acute (aGVHD) or chronic form of GVHD (cGVHD) following HSCT: aGVHD affects 30%-70% of recipients, while cGVHD occurs in 20%-70% of recipients[ 78 , 79 ]. cGVHD is a major complication in 40%-60% of patients after HSCT and is manifested in multiple organs, including the oral cavity, liver, lung, skin, and eyes[ 80 ]. Chronic GVHD is a frequent cause of long-term morbidity and non-relapse mortality, and affected patients have a significantly impaired QOL, compared with population norms and patients without GVHD symptoms[ 81 , 82 ].…”

Depression following graft-versus-host disease in a patient with acute lymphoblastic leukaemia: A case report

“…GVHD is a common complication of allogeneic HCT (11). Acute GVHD occurs within the first 100 days of transplantation and presents with manifestations of the skin, gastrointestinal mucosa and liver.…”