Do patients who are treated with stem cell transplantation have a health-related quality of life comparable to the general population after 1 year?

Abstract

Summary:Health-related quality of life (HRQOL) in leukemia and lymphoma patients treated with high-dose chemotherapy followed by allogeneic (SCT) and autologous (ASCT) stem cell transplantation or receiving combination chemotherapy (CT) was prospectively assessed by the EORTC QLQ-C30 and compared with reference data from a general population sample. One year after transplant, the SCT group had functional scores which were close to population values except for lower social (P Ͻ 0.0001) and role function (P = 0.0004). More symptoms and problems were reported, especially appetite loss (P = 0.001) and financial difficulties (P = 0.0001). The ASCT patients reported a less than optimal HRQOL relative to the population 1 year post transplant. Cognitive, physical, role, and social function, dyspnoea, financial difficulties and global quality of life were most impaired (P Ͻ 0.001). In the CT group, physical, role and social function, dyspnoea and financial difficulties were impaired 1 year after start of chemotherapy, compared with the general population (P Ͻ 0.001). The EORTC QLQ-C30 was supplemented by a high-dose chemotherapy module, the HDC-19, at the 1-year assessment, but no consistent differences were found across groups. Fifteen to 34% of the patients expressed fears of relapse and worries about future health, while 24-30% indicated no participation in sexual activities. Keywords: health-related quality of life; high-dose chemotherapy; stem cell transplantation; treatment sideeffects; reference data; EORTC QLQ-C30 Some studies evaluating health-related quality of life (HRQOL) in cancer patients treated with high-dose chemotherapy (HDC) followed by allogeneic bone marrow or blood stem cell transplantation (SCT) or reinfusion of autologous bone marrow or blood stem cells (ASCT) have used generic HRQOL questionnaires. Those that possess suf- The SF-36 was employed in a Canadian cross-sectional study of 231 SCT patients at a median time of 40 months post transplant (range 1-253). 4 Compared with the general American population, the patients had significantly lower scores for physical and social function, role-emotional and role-physical function and general health, deviating with 5 to 30 on the 0 to 100 scales. A Spanish study used the NHP to assess HRQOL in a cross-sectional sample of 117 SCT and ASCT patients with a median follow-up of 55 months (range 6-154).5 Lack of energy and problems related to work, sexuality and physical mobility were more prevalent than reported from a British general population sample. The only prospective study employing a generic HRQOL tool showed that 39% of the 67 patients had a pre-transplant overall SIP score which was at least 1 standard deviation above the general population mean, indicating impaired functioning. 6The EORTC QLQ-C30 7 is a cancer-specific questionnaire and might be more suitable for cancer populations than generic questionnaires, since it focuses on problems commonly experienced by cancer patients. Specific problems pertaining to the cancer diagnosis or treatment ca...

Sleep disturbances and emotional distress in the acute course of hematopoietic stem cell transplantation

“…37,38 In our study, female patients did not differ significantly from males regarding anxiety and/or depression. The literature is inconsistent regarding this issue: some studies show a better sleep quality of men, 15,39 whereas others describe no differences regarding concerning gender. 6,36,40 Our results indicate different temporal courses of sleep quality regarding the type of transplant.…”

A controlled randomized study examining the effects of exercise therapy on patients undergoing haematopoietic stem cell transplantation

“…Complications such as muscle atrophy, loss of physical performance, cachexia, pneumonia, GVHD and deterioration of the psychological condition are clearly more common in allogeneic than in autologous transplants. [26][27][28][29] The aims of a physical activity plan could include a narrowing down of these complications and their consequences.…”

Health Related Quality of Life in stem cell transplantation: Clinical and psychometric validation of the questionnaire module, High Dose Chemotherapy (HDC-19)

“…As no specific questionnaires for evaluating HRQOL after SCT were currently available, Hjermstad and colleagues [15] developed a 19-item HighDose-Chemotherapy module (HDC-19) for this purpose in their prospective study of autologous and allogeneic STC patients [15]. This ad-hoc module was developed according to the guidelines set forth by the EORTC [14] and focuses on physical symptoms and psychological problems related to SCT not covered by the core questionnaire, EORTC QLQ-C30.…”

“…In phase II, items were operationalised and formatted to the same four-point response categories as in the core questionnaire. In phase III, the provisional module was first pilot-tested in ten patients and subsequently in a larger study with 177 patients [15]. The increased use of stem cell transplantation and the raised awareness of the need for more thorough assessments of its physical and psychological side effects, engendered in part by findings from the unofficial HDC-19, contributed to the development of an official EORTC HDC module, the HDC29.…”

“…The present study is part of that project. As the work in the EORTC HDC group was in its infancy and no official treatment-specific module was available at study start, it was decided to use the HDC-19 developed by Hjermstad and colleagues [15] to supplement the EORTC QLQ-C30.…”