Resilience, health, and quality of life among long‐term survivors of hematopoietic cell transplantation

Abstract

Background Low patient-reported resilience is associated with ongoing risk of poor health and psychosocial outcomes. Using a large cross-sectional sample of survivors of Hematopoietic Cell Transplantation (HCT), we explored associations between patient-reported resilience, psychological distress, post-traumatic growth, and health-related quality of life Methods Between July 1, 2013 and June 30, 2014, the annual Fred Hutchinson Cancer Research Center (FHCRC) post-transplant survivorship survey queried patient-reported health and functional status, and included instruments assessing psychosocial outcomes: the 10-item Connor-Davidson Resilience Scale, the Post-Traumatic Growth Inventory, the Cancer and Treatment Distress measure, and the Medical Outcomes Study Short-Form 12 quality of life scale. Multivariate linear and logistic regression models included demographic and health covariates extracted from the FHCRC research database Results 1,823 (39%) of 4,643 adult survivors of HCT responded after a single mailing and subsequent reminder letter. Participants’ median age was 59 years (IQR 50–66); 52.3% were male, most were non-Hispanic, white. The median time since HCT was 9 years (IQR 3–18). Lower patient-reported resilience was associated with higher severity chronic graft-versus-host disease, lower performance scores, missing work due to health, and permanent disability (all p<0.0001). After adjustment for demographic and health characteristics, patients reporting low resilience scores had higher odds of psychological distress (OR 3.0, 95% CI 2.1–4.3) and being in the lowest quartile of mental health-related quality of life (OR 5.9, 95% CI 4.4–8.0). Conclusions Patient-reported resilience is independently associated with health and psychosocial outcomes. Future studies must determine whether interventions can bolster resilience and improve survivorship outcomes.

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