Psychosocial risk predicts high readmission rates for hematopoietic cell transplant recipients

Abstract

Hematopoietic cell transplantation (HCT) is an intensive treatment resulting in disease control however subsequent psychosocial distress is common. Screening for psychosocial risk factors that contribute to morbidity is underutilized; moreover, the value in screening is uncertain. We performed a retrospective study of 395 HCT patients who were screened for psychosocial risk using the Transplant Evaluation Rating Scale (TERS). Patients were classified by psychosocial risk as no-risk (TERS = 26.5, 52%) vs. at-risk (TERS > 26.5, 48%), with at-risk patients stratified by cumulative deficits into mild risk (TERS = 27-35.5, 39%) and moderate risk (TERS > 35.5, 9%). At-risk patients were more likely to be readmitted within 90 days (mild risk HR = 1.62, p = 0.02, moderate risk HR = 2.50, p = 0.002). Prior psychiatric history (HR = 1.81, p = 0.002) and poor coping skills (HR = 1.64, p = 0.04) also influenced readmission. At-risk patients were more likely to be readmitted for infection (no-risk = 12% vs. at-risk = 25%, p = 0.002). Pre-HCT screening with the TERS did not predict survival or length of stay although at-risk patients are at a heighted risk of readmission. Implementing strategies to reduce readmission in higher risk patients is warranted.

Psychosocial Pre-Transplant Screening With the Transplant Evaluation Rating Scale Contributes to Prediction of Survival After Hematopoietic Stem Cell Transplantation

“…Describing and analyzing risks in advance should be an important element in modern HSCT therapy. Prior studies with different approaches have demonstrated an association between psychosocial pre-transplant risk factors and therapy success in HSCT patients, affecting length of hospitalization, readmission rates and overall survival (13,19,25,(29)(30)(31)(32)(33)(34)(35). Hoodin et al used TERS multiple times, in a 5-year follow-up study as well as in a 2003 study, but TERS scores were assigned retrospectively (16,20).…”

“…In a recent study, adherence was measured 60-180 days post-transplant using a self-administered questionnaire, which showed that 54.6% of patients were poorly adherent (12). Prior studies have examined the relationship between adherence, psychosocial variables, and outcome after both solid organ and stem cell transplantation (13)(14)(15). Psychosocial factors, such as prior psychiatric history or poor coping skills, have a significant impact on survival after HSCT (13).…”

“…Prior studies have examined the relationship between adherence, psychosocial variables, and outcome after both solid organ and stem cell transplantation (13)(14)(15). Psychosocial factors, such as prior psychiatric history or poor coping skills, have a significant impact on survival after HSCT (13). Screening tools, such as the Transplant Evaluation Rating Scale (TERS), have been introduced and used to evaluate the psychosocial aspects of HSCT in advance (16)(17)(18).…”

“…Screening tools, such as the Transplant Evaluation Rating Scale (TERS), have been introduced and used to evaluate the psychosocial aspects of HSCT in advance (16)(17)(18). A pre-transplant survey has been shown to predict psychosocial outcomes 12 months after transplantation, while others have shown that higher psychosocial strain correlates with higher readmission rates (13,15). A previous retrospective study showed that lower TERS scores could predict a benefit in overall survival in a 1-year follow-up; further, it was found that HSCT recipients had lower readmission rates 90 days after transplantation (13,15).…”

“…A pre-transplant survey has been shown to predict psychosocial outcomes 12 months after transplantation, while others have shown that higher psychosocial strain correlates with higher readmission rates (13,15). A previous retrospective study showed that lower TERS scores could predict a benefit in overall survival in a 1-year follow-up; further, it was found that HSCT recipients had lower readmission rates 90 days after transplantation (13,15). A prospective study noted a survival advantage after HSCT, for low/moderate-risk patients compared with high-risk patients at day 100, 1 year and overall with a median follow-up of 48 months (19).…”