Impact of Delirium on Cognition, Distress, and Health-Related Quality of Life After Hematopoietic Stem-Cell Transplantation

Fann, Jesse R.; Alfano, Catherine M.; Roth-Roemer, Sari; Katon, Wayne; Syrjala, Karen L.

doi:10.1200/jco.2006.07.9079

Cited by 69 publications

(61 citation statements)

References 91 publications

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“…It is plausible that had more comprehensive symptom measures been selected and applied in this population [60,[72][73][74] additional symptoms, than those reported in this study, may have emerged as prevalent. As a secondary analysis, this study was constrained by the use of an instrument that evaluates only two aspects of the symptom experience: symptom occurrence and symptom distress.…”

Section: Discussionmentioning

confidence: 63%

“…Poor sleep quality can result from frequent awakenings and from the administration of medications that interfere with sleep quality and cause disruption to usual sleep patterns [57][58][59]. In addition, delirium which is characterized by sleep-wake cycle disturbances may contribute to higher levels of fatigue in patients undergoing autologous and allogeneic HSCT [60]. Although a recent review concludes that a strong interrelationship may exist between cancer-related fatigue and sleep disorders [61], the prevalence and correlates of fatigue and poor sleep quality in patients undergoing HSCT have not been systematically examined, and such studies are fundamental to the development of effective interventions to improve these symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Several other reports describe gastrointestinal symptoms, together with fatigue, and sleep disturbance in the early post-transplant period [9]. The effects of the pre-transplant conditioning regimen together with the nadir of blood counts, de-conditioning, sedating medications, and other physiologic and psychological events [60,69] in the early post-transplant period may account for this clustering, and have been described in mixed allogeneic and autologous recipient populations [72]. However, by Day 30 acute GVHD surfaces as an additional explanatory factor for the continued presence of this specific cluster [79].…”

Section: Discussionmentioning

confidence: 99%

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The symptom experience in the first 100 days following allogeneic hematopoietic stem cell transplantation (HSCT)

Bevans

Mitchell

Marden

2008

Support Care Cancer

180

133

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Goals of Work-Despite advances in allogeneic hematopoietic stem cell transplantation (HSCT), post-transplant complications are common and patients' symptom experience has not been well documented.Purpose-To characterize the symptom experience of adult patients pre-transplantation and days 0, 30 and 100 after allogeneic HSCT.Methods-Data from 76 participants enrolled in a prospective Health-Related Quality of Life (HRQL) study were used. Symptom occurrence, distress, and clusters were determined based on the 11 symptoms of the Symptom Distress Scale (SDS).Results-Participants were on average 40 years old (SD ± 13.5). The majority (54%) received reduced intensity conditioning. Prevalent symptoms included fatigue (68%) and worry (68%) at baseline; appetite change (88%) at day 0; and fatigue at days 30 (90%) and 100 (81%). Participants reported the following symptoms as severely distressing: worry (16%) [baseline], insomnia (32%) [Day 0], appetite change (22%) [Day 30] and fatigue (11%) [Day 100]. The total SDS score was highest at day 0 (M = 26.6 ± 7.6) when the highest number of symptoms were reported [Mdn = 8 (1 -11)]. Symptoms formed clusters comprised of fatigue, appearance change, and worry at baseline, and fatigue, insomnia and bowel changes at days 0 and 30. Compared to those with low symptom distress, participants with moderate/severe symptom distress reported poorer HRQL. Conclusion-AllogeneicHSCT patients present for transplantation with low symptom distress yet experience multiple symptoms and high symptom distress after HSCT conditioning. Understanding the symptom experience of allogeneic HSCT patients can guide management strategies and improve HRQL.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The symptom experience in the first 100 days following allogeneic hematopoietic stem cell transplantation (HSCT)

Bevans

Mitchell

Marden

2008

Support Care Cancer

180

133

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“…A delirium episode was defined as a DRS score more than 12 or delirium based on the DSM-IV checklist on at least 2 of 3 consecutive assessments. 14,[19][20][21] Neuropsychologic testing assessed the following domains: (1) Overall, 144 (49%) of 291 patients Ն 5 years old completed both baseline and follow-up neurocognitive testing. Of the 176 missed tests, 83 were the result of severe illness or death and 93 were refused or unable to be scheduled.…”

Section: Neuropsychiatric and Neurocognitive Assessmentsmentioning

confidence: 99%

HHV-6 reactivation and its effect on delirium and cognitive functioning in hematopoietic cell transplantation recipients

Zerr

Fann

Breiger

et al. 2011

Blood

Self Cite

125

101

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Human herpesvirus 6 (HHV-6) is detected in the plasma of approximately 40% of patients undergoing hematopoietic cell transplantation (HCT) and sporadically causes encephalitis in this population. The effect of HHV-6 reactivation on central nervous system function has not been fully characterized. This prospective study aimed to evaluate associations between HHV-6 reactivation and central nervous system dysfunction after allogeneic HCT. Patients were enrolled before HCT. Plasma samples were tested for HHV-6 at baseline and twice weekly after transplantation until day 84. Delirium was assessed at baseline, 3 times weekly until day 56, and weekly on days 56 to 84 using a validated instrument. Neurocognitive testing was performed at baseline and at approximately day 84. HHV-6 was detected in 111 (35%) of the 315 included patients. Patients with HHV-6 were more likely to develop delirium (adjusted odds ratio ‫؍‬ 2.5; 95% confidence interval, 1.2-5.3) and demonstrate neurocognitive decline (adjusted odds ratio ‫؍‬ 2.6; 95% confidence interval, 1.1-6.2) in the first 84 days after HCT. Cord blood and unrelated transplantation increased risk of HHV-6 reactivation. These data provide the basis to conduct a randomized clinical trial to determine whether prevention of HHV-6 reactivation will reduce neurocognitive morbidity in HCT recipients. (Blood. 2011;117(19):5243-5249)

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“…Thus, J. Fann et al (2007) note that in patients who had delirium during myeloablative hematopoietic stem cell transplantation (CCTS), within 80 days after suffering a psychosis preserved cognitive impairment [20] . Among other disorders reported about the development of paranoid psychosis in ALL patient, where after the antipsychotic treatment step, which led to pernicious narcolepsy, it was chosen the electroconvulsive therapy (ECT) as a therapeutic method [11] .…”

Section: Somatogenic Psychosesmentioning

confidence: 99%

Psychohematology. Attempt to Summarise

Выборных

Olexenko

Savchenko

2016

International Journal of Hematology Research

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AIM:This article describes studies involving mental and personality disorders in patients with blood diseases -disorders typology, prevalence, risk factors for developing of mental disturbances and their treatment. METHODS:The work is done on the basis of scientific literature search in various databases and analysis of the resulting material. RESULTS: There was obtained information on the prevalence, typologies, risk factors and treatment of blood diseases in the available literature. CONCLUSIONS: The presented data of literature suggests clinical heterogeneity and a wide range (from asthenic reactions to delirious states) of psychopathological disorders detected in blood diseases patients. The main risk factors are severe underlying disease, chemotherapy management (especially corticosteroids), elderly patients. In most cases of adjustment disorders there was observed a combination of several risk factors (both general and specific). In the context of the tolerability and safety of pharmacotherapy preference was given to atypical antipsychotics and new generations of antidepressants (SSRI, SNRI). It remains to study the mental disorders and personality disorders, which are formed in patients with specific malignant and nonmalignant (hemophilia, thrombocytopathy etc.) diseases and to develop differentiated approaches to pharmacotherapy and psychotherapy in such states.

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Impact of Delirium on Cognition, Distress, and Health-Related Quality of Life After Hematopoietic Stem-Cell Transplantation

Abstract: Patients with a malignancy who experience delirium during myeloablative HSCT showed impaired neurocognitive abilities and persistent distress 80 days after transplantation. Effective prevention or treatment of delirium during HSCT may improve both cognitive and psychological outcomes.

Cited by 69 publications

References 91 publications

The symptom experience in the first 100 days following allogeneic hematopoietic stem cell transplantation (HSCT)

The symptom experience in the first 100 days following allogeneic hematopoietic stem cell transplantation (HSCT)

HHV-6 reactivation and its effect on delirium and cognitive functioning in hematopoietic cell transplantation recipients

Psychohematology. Attempt to Summarise

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