Fear of cancer recurrence, distress, depressive symptoms, and quality of life in hematopoietic stem cell transplantation patients

Abstract

Background: Symptoms of psychological distress, including fear of cancer recurrence (FCR) and quality of life (QOL) deficits are common along the hematopoietic stem cell transplantation (HCT) survivorship trajectory. Identifying patterns over time could contribute to timely interventions. Materials and Methods: HCT recipients completed the Distress Thermometer (DT), the Center for Epidemiologic Studies-Depression scale (CES-D), the Fear of Relapse and Recurrence Scale, and the Functional Assessment of Cancer Therapy (FACT-BMT) at hospital admission, discharge, 3, 6, 12, and 24 months post-HCT. Demographic data and performance status (PS) were collected at baseline. Mean scores (standard deviation) and frequencies were calculated. We utilized a linear mixed model approach on the repeated measures data (outcome of FCR, with predictors of distress, depressive symptoms and QOL). A multivariate repeated measures regression was constructed to assess what variables were associated with FCR. Results: A total of 198 patients completed questionnaires at admission. A total of 144 patients were deceased or lost to follow-up at 2 years. Both CES-D (P = .006) and DT (P = .0019) scores changed significantly over time and were higher at hospital discharge. FCR did not change significantly (P = .28). QOL was most impaired at hospital discharge. FCR did not correlate with actual recurrence. A significant percentage of recipients were afraid of cancer recurrence; however, a much greater percentage did not feel that fear of recurrence got in the way of enjoying life. QOL (P < .0001) and PS (P = .014) were significant predictors of FCR. A substantial percentage of patients reported significant (>16) depressive symptoms and distress levels (≥4) during the 2-year study period. Conclusions: Depressive symptoms and distress were highest at discharge, whereas overall QOL was lowest. FCR was prominent; yet for the majority, it was not an impediment to enjoying life. A psychosocial intervention may be most useful if introduced at hospital discharge and initiated during the first 3 months following HCT when distress is high.

Digital Life Coaching During Stem Cell Transplantation: Development and Usability Study

“…Our DLC intervention began on day −5 of SCT, which preceded hospital admission for high-dose chemotherapy by 2-3 days. Our rationale for this time frame was to focus on the acute posttransplant period itself, a time during which QOL is known to decrease because of increased symptom burden and acute life disruptions [ 11 - 15 ]. However, in contrast to 2 prior studies that demonstrated that distress peaked at count nadir or hospital discharge [ 3 , 15 ], this study found that elevated distress was highest at pre-SCT baseline.…”

“…Our rationale for this time frame was to focus on the acute posttransplant period itself, a time during which QOL is known to decrease because of increased symptom burden and acute life disruptions [ 11 - 15 ]. However, in contrast to 2 prior studies that demonstrated that distress peaked at count nadir or hospital discharge [ 3 , 15 ], this study found that elevated distress was highest at pre-SCT baseline. As a second observation of note, our narrow pre-SCT window also precluded participation for 1 of our 15 enrolled patients who was unable to connect with her coach before hospitalization.…”

Biobehavioral Implications of Covid-19 for Transplantation and Cellular Therapy Recipients

“…Cancer development and progression, as well as TCT treatment, alter innate and adaptive immune function (12). The significant stress associated with a cancer diagnosis, treatment, and accompanying life disruption can also adversely affect immune function (13,14). Specifically, stress and adverse psychosocial factors alter neural and endocrine pathways that ultimately affect gene regulation in immune cells (15)(16)(17)(18)(19).…”

Mediating effect of ill perception on the relationship between social constraints and fear of cancer recurrence among adolescent and young adult survivors who underwent hematopoietic stem cell transplantation

“… 3 , 4 At present, the risk of cancer recurrence is a significant factor affecting HSCT survivors. 5 , 6 For example, previous studies have shown that the incidence of FCR in HSCT survivors is about 50%–90% 5 , 7 , 8 being more severe among survivors who are 55 years old and younger compared with those older than 55 years. 8 However, none of these studies described specific details of the adolescent and young adult (AYA) age group who underwent HSCT.…”