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Amonoo HL, Guo M, Keane EP, Boardman AC, Song MT, Wolfe ED, Cutler C, Jim HS, Lee SJ, Huffman JC, El-Jawahri A. A Peer Support Intervention in Patients With Hematologic Malignancies Undergoing Hematopoietic Stem Cell Transplantation (HSCT): The STEPP Proof-of-Concept Trial. Transplant Cell Ther 2024; 30:1217.e1-1217.e15. [PMID: 39332809 PMCID: PMC11620926 DOI: 10.1016/j.jtct.2024.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 09/19/2024] [Accepted: 09/20/2024] [Indexed: 09/29/2024]
Abstract
Although peer support interventions are associated with improved patient-reported outcomes in diverse cancer populations, structured peer support programs tailored to the needs of patients undergoing hematopoietic stem cell transplantation (HSCT) are lacking. This single-arm, proof-of-concept trial aimed to refine the Supporting Transplant Experiences with Peer Program (STEPP), a structured, five-session, manualized, phone-delivered peer support intervention for patients undergoing HSCT, informed by qualitative feedback from patients. Adult patients with hematologic malignancies scheduled to undergo allogeneic or autologous HSCT were eligible to participate in the study approximately two weeks prior to their HSCT hospitalization. Participants received the STEPP intervention, which focused on providing informational, emotional, and practical support. To refine the intervention, we conducted semi-structured qualitative exit interviews to gather feedback on the content of STEPP and to identify facilitators and barriers to engagement. Transcribed interviews were analyzed using rapid analytic methods by two coders. Of the 37 eligible patients, 25 enrolled in the study, 20 completed all intervention sessions and 20 completed exit interviews. Participants highlighted that discussions with peer mentors/STEPP interventionists about the transplant journey and processing information provided by the clinical team were the most valuable aspects of STEPP. Positive experiences during the first intervention session facilitated patient engagement with the program. Potential barriers to engagement included logistical challenges in connecting with interventionists while experiencing physical symptoms during inpatient hospitalization and being paired with an interventionist who had a different cancer diagnosis and/or type of transplant. Patients undergoing HSCT reported positive experiences with the structured five-session, phone-delivered peer support intervention administered before and during the HSCT hospitalization. Patients' descriptions of barriers and facilitators to engagement with the STEPP intervention underscore the importance of patient input and programmatic structure in peer support interventions for this population. Insights from this proof-of-concept trial will be incorporated into future trials of STEPP to improve outcomes in HSCT recipients.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Michelle Guo
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Emma P Keane
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - M Tim Song
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Emma D Wolfe
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Corey Cutler
- Harvard Medical School, Boston, Massachusetts; Division of Transplantation and Cellular Therapy, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Heather S Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Center and Division of Hematology-Oncology, University of Washington, Seattle, Washington
| | - Jeff C Huffman
- Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Mass General Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
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Mozafari S, Yang A, Talaei-Khoei J. Health Locus of Control and Medical Behavioral Interventions: Systematic Review and Recommendations. Interact J Med Res 2024; 13:e52287. [PMID: 39388686 PMCID: PMC11502985 DOI: 10.2196/52287] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/14/2024] [Accepted: 06/26/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Health locus of control (HLOC) is a theory that describes how individuals perceive different forces that influence their lives. The concept of a locus of control can affect an individual's likelihood to commit to behaviors related to their health. This study explores the literature on the relationships between HLOC and medical behavioral interventions. OBJECTIVE This study aims to better understand how HLOC constructs can potentially affect patient responses to health behavioral interventions and to propose a series of guidelines for individuals interested in designing medical behavioral interventions related to HLOC. METHODS We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology and performed an analysis of 50 papers related to the topic of HLOC and medical behavioral interventions. Inclusion criteria were studies that had a behavioral intervention involving patients and contained a metric of at least 1 of the constructs related to HLOC. The initial screening and search were conducted by 2 researchers (AY and SM) separately. The results were then combined and compared. RESULTS Our findings explore the influence of different levels of HLOC along with the importance of both patient- and health-related context when assessing the relationships between HLOC constructs and the likelihood of health behavior change. The findings show that different constructs related to HLOC can act as reliable predictors for patient responses to medical behavioral interventions. Patients who score higher on internal HLOC measures are more likely to exhibit behaviors that are consistent with positive health outcomes. Patients who score higher on chance HLOC are more likely to exhibit behaviors that may lead to adverse health outcomes. These conclusions are supported by most of the 50 studies surveyed. CONCLUSIONS We propose guidelines for individuals designing medical behavioral interventions so that they can make use of these relationships linked to HLOC. The three guidelines suggested are as follows: (1) in most situations, improving internal HLOC will improve health outcomes for patients; (2) patients with high external HLOC should be further studied to determine the source of the external HLOC; and (3) patients with a high chance HLOC are less likely to follow preventative behaviors or be responsive to interventions. Limitations of the study are that the primary search and analysis were conducted by 2 principal researchers (AY and SM). Interpretation and development of the guidelines are subject to individual interpretation of results and may not be applicable to all contexts.
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Affiliation(s)
- Sogol Mozafari
- Department of Information Systems, College of Business, University of Nevada, Reno, Reno, NV, United States
| | - Alan Yang
- Department of Information Systems, College of Business, University of Nevada, Reno, Reno, NV, United States
| | - Jason Talaei-Khoei
- Department of Information Systems, College of Business, University of Nevada, Reno, Reno, NV, United States
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Purdy GM, Nanad R, Ternes L, Dolgoy ND, Sellar CM, Francis G, Crisp N, Pituskin E, de Guzman Wilding M, Perry S, Sandhu I, Venner CP, McNeely ML. Exercise Preferences, Barriers, and Facilitators of Individuals With Cancer Undergoing Chemotherapy Before Stem Cell Transplantation: A Mixed-Methods Study. Cancer Nurs 2024; 47:E287-E297. [PMID: 37058603 DOI: 10.1097/ncc.0000000000001240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Exercise can help mitigate side effects of hematopoietic stem cell transplantation (HSCT), particularly when initiated before HSCT. However, the exercise-related barriers, facilitators, and preferences of this population remain unclear. OBJECTIVE This study aimed to explore the patient experience to inform future implementation of a prehabilitation intervention. INTERVENTIONS/METHODS A 2-phase sequential explanatory mixed-methods study was conducted using (1) cross-sectional survey and (2) focus groups. Survey questions aligned with the Theoretical Domains Framework. Focus group data were analyzed using a directed content analysis approach, followed by inductive thematic analysis to generate themes that represented the exercise-related barriers, facilitators, and preferences of participants. RESULTS Twenty-six participants completed phase 1 (n = 22 with multiple myeloma). Fifty percent of participants (n = 13) were fairly/very confident in their ability to exercise pre-HSCT. Eleven participants completed phase 2. Exercise barriers included knowledge/skill limitations, inadequate healthcare provider support, and the emotional toll of treatment. Facilitators included social support and goals. Exercise preferences were related to 2 themes: (1) program structure (subthemes: prescription and scheduling, mode of delivery) and (2) support (subthemes: support from personnel, tailoring, and education). CONCLUSION Key exercise-related barriers included knowledge limitations, disease/treatment effects, and inadequate support. Prehabilitation should be tailored, flexible, and include education and a virtual or hybrid delivery model in this population. IMPLICATIONS FOR PRACTICE Nurses are well positioned to identify functional limitations and counsel and refer patients to exercise programming and/or physiotherapy services. Including an exercise professional in the pretransplant care team would provide key supportive care assistance for the nursing team.
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Affiliation(s)
- Graeme M Purdy
- Author Affiliations: Department of Physical Therapy, Faculty of Rehabilitation Medicine (Mr Purdy, Mrs Nanad, Mrs Ternes, and Drs Dolgoy, Sellar, and McNeely), and Faculty of Nursing (Dr Pituskin), University of Alberta, Edmonton, Alberta; Cumming School of Medicine, University of Calgary, Calgary, Alberta (Drs Francis and Perry); Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta (Mrs Crisp); Department of Oncology, Cross Cancer Institute, Edmonton, Alberta (Drs Pituskin, Sandhu, and Venner); Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada (Mrs de Guzman Wilding and Drs Perry and McNeely)
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Geeck K, Kreil S, Hausmann M, Hofmann WK, Heidenreich D, Klein SA. Prospective analysis of the attendance behaviour of the participants of a facilitated support group for patients after allogeneic hematopoietic cell transplantation. Support Care Cancer 2023; 32:63. [PMID: 38150035 PMCID: PMC10752839 DOI: 10.1007/s00520-023-08279-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 12/18/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Support groups might help survivors of allogeneic hematopoietic cell transplantations (HCT) to cope with medical, psychological, and social challenges. The aim of this project was (1) to establish a facilitated post-HCT support group and (2) to assess the participation behaviour. METHODS From 11/2013 until 7/2017, all adult patients who had received a HCT at our centre were invited to participate in a professionally facilitated support group. The format of the group was unstructured without any rules regarding regular attendance. The attendance was prospectively minuted by the facilitator. Reasons for non-attendance were assessed by a survey. RESULTS During the observation period, 53 group meetings were scheduled. Nine meetings were cancelled because of low attendance. Altogether 23 different patients (F: n=10; M: n=13) and 10 spouses (F: n=9; M: n=1) participated. Median participation was 5 [range 2-11]. With respect to all HCT patients who had the theoretical opportunity to attend, the mean participation rate was 7%. Thirteen patients and four spouses attended more than one meeting. The median count of participations among those participants was 8 [2-32]. The median interval from the first until the last participation was 16 months. The main reason reported for non-participation was the effort to get to the venue of the support group. CONCLUSIONS To our knowledge, this is the first analysis on the attendance behaviour of the participants of a support group for HCT survivors. The results provide guidance for the organization of future support groups and indicate what participation rates can be expected and how they might be increased.
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Affiliation(s)
- Karsten Geeck
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany
| | - Sebastian Kreil
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany
| | - Michaela Hausmann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany
| | - Wolf-Karsten Hofmann
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany
| | - Daniela Heidenreich
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany
| | - Stefan A Klein
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany.
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Kirtane K, Reblin M, Oswald LB, Irizarry-Arroyo N, McCormick R, Locke FL, Ketcher D. Psychosocial characteristics of patients undergoing cellular immunotherapies and their caregivers across time. Leuk Lymphoma 2023; 64:364-370. [PMID: 36416677 DOI: 10.1080/10428194.2022.2148216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Chimeric antigen receptor T-cells and other immunotherapies have markedly changed the paradigm of treatment for patients with relapsed or refractory hematologic malignancies. While notable in efficacy, immunotherapy is characterized by a significant possibility of life-threatening side effects. Consequently, patients are often required to have informal family caregivers present and to stay near the treating center for several weeks after cell infusion. Further, the responsibility of managing a great deal of physical care and emotional support falls to these caregivers. Given the novelty of immunotherapy treatment, there is a need to better understand the psychosocial experience of patients receiving this treatment and their caregivers. This article describes the psychosocial characteristics of patients undergoing cellular immunotherapies and their caregivers across time, including patient/caregiver distress, coping, and caregiver burden and preparedness.
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Affiliation(s)
- Kedar Kirtane
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Maija Reblin
- Department of Family Medicine, University of Vermont, Burlington, VT, USA
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Rachael McCormick
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Frederick L Locke
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - Dana Ketcher
- University of Minnesota Medical School, Duluth Campus, MN, USA
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Amonoo HL, Harnedy LE, Staton SC, Longley RM, Daskalakis E, El-Jawahri A, Huffman JC. Peer support in patients with hematologic malignancies: a systematic review. Bone Marrow Transplant 2022; 57:1240-1249. [PMID: 35597891 DOI: 10.1038/s41409-022-01709-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/29/2022] [Accepted: 05/06/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Peer support has been utilized and associated with clinical outcomes (e.g., improved mood) in patients with solid malignancies. However, to date, there is minimal literature examining peer support among patients with hematologic malignancies and/or patients who have undergone hematopoietic stem cell transplantation (HSCT). METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we completed a systematic review using five databases to assess the relationship between peer support and clinical outcomes (e.g., distress, physical symptoms) among patients with hematologic malignancies or HSCT recipients. RESULTS The eight included studies examined peer support in a total of 574 patients. Four intervention studies highlighted the potential benefits of peer support, such as improved physical symptoms. Two studies, one interventional and one cross-sectional, highlighted the need for more empirically based peer support interventions in the HSCT population. CONCLUSION Among patients with hematologic malignancies and/or HSCT recipients, there is a dearth of literature examining the association between peer support and outcomes, although few studies have described a positive association between peer support and better health outcomes. More randomized controlled studies are needed to better understand the role of peer support and peer support interventions on outcomes in these vulnerable populations.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. .,Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Lauren E Harnedy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Sophie C Staton
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Areej El-Jawahri
- Harvard Medical School, Boston, MA, USA.,Mass General Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - Jeff C Huffman
- Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Sheikh IN, Miller J, Shoberu B, Andersen CR, Wang J, Williams LA, Mahadeo KM, Robert R. Using the MDASI-Adolescent for Early Symptom Identification and Mitigation of Symptom Impact on Daily Living in Adolescent and Young Adult Stem Cell Transplant Patients. CHILDREN 2021; 9:children9010019. [PMID: 35053644 PMCID: PMC8774132 DOI: 10.3390/children9010019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/10/2021] [Accepted: 12/18/2021] [Indexed: 11/16/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) requires an intensive pre- and post-procedure course that leads to symptoms including fatigue, nausea/vomiting, and pain, all of which interfere significantly with activities of daily living. These symptoms place a substantial burden on patients during the time period surrounding transplant as well as during long-term recovery. The MD Anderson Symptom Inventory (MDASI) is a symptom-reporting survey that has been successfully used in adult patients with cancer and may have utility in the adolescent and young adult (AYA) population. At the Children’s Cancer Hospital at MD Anderson Cancer Center, we adopted a modified version of the MDASI, the MDASI-adolescent (MDASI-Adol), as a standard of care for clinical practice in assessing the symptom burden of patients in the peri-transplant period. We then conducted a retrospective chart review to describe the clinical utility of implementing this symptom-screening tool in AYA patients admitted to our pediatric stem cell transplant service. Here, we report our findings on the symptom burden experienced by pediatric and AYA patients undergoing stem cell transplantation as reported on the MDASI-Adol. Our study confirmed that the MDASI-Adol was able to identify a high symptom burden related to HSCT in the AYA population and that it can be used to guide symptom-specific interventions prior to transplant and during recovery. Implementing a standard symptom-screening survey proved informative to our clinical practice and could mitigate treatment complications and alleviate symptom burden.
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Affiliation(s)
- Irtiza N. Sheikh
- Department of Pediatrics, Pediatric Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (J.M.); (B.S.); (K.M.M.)
- Correspondence: (I.N.S.); (R.R.)
| | - Jeffrey Miller
- Department of Pediatrics, Pediatric Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (J.M.); (B.S.); (K.M.M.)
| | - Basirat Shoberu
- Department of Pediatrics, Pediatric Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (J.M.); (B.S.); (K.M.M.)
| | - Clark R. Andersen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (C.R.A.); (J.W.)
| | - Jian Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (C.R.A.); (J.W.)
| | - Loretta A. Williams
- Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Kris M. Mahadeo
- Department of Pediatrics, Pediatric Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (J.M.); (B.S.); (K.M.M.)
| | - Rhonda Robert
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence: (I.N.S.); (R.R.)
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Whitmore L, Schulte T, Bovbjerg K, Hartstein M, Austin J, Luta G, McFarland L, Rowley SD, Nyirenda T, Lewis-Thames M, Stanton AL, Valdimarsdottir H, Graves K, Rini C. Efficacy of expressive helping in adult hematologic cancer patients undergoing stem cell transplant: protocol for the Writing for Insight, Strength, and Ease (WISE) study's two-arm randomized controlled trial. Trials 2021; 22:722. [PMID: 34670600 PMCID: PMC8527764 DOI: 10.1186/s13063-021-05676-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background During, shortly after, and sometimes for years after hematopoietic stem cell transplant, a large proportion of hematological cancer patients undergoing transplant report significant physical and psychological symptoms and reduced health-related quality of life. To address these survivorship problems, we developed a low-burden, brief psychological intervention called expressive helping that includes two theory- and evidence-based components designed to work together synergistically: emotionally expressive writing and peer support writing. Building on evidence from a prior randomized control trial showing reductions in physical symptoms and distress in long-term transplant survivors with persistent survivorship problems, the Writing for Insight, Strength, and Ease (WISE) trial will evaluate the efficacy of expressive helping when used during transplant and in the early post-transplant period, when symptoms peak, and when intervention could prevent development of persistent symptoms. Methods WISE is a multi-site, two-arm randomized controlled efficacy trial. Adult hematological cancer patients scheduled for a hematopoietic stem cell transplant will complete baseline measures and then, after hospitalization but prior to transplant, they will be randomized to complete either expressive helping or a time and attention “neutral writing” task. Both expressive helping and neutral writing involve four brief writing sessions, beginning immediately after randomization and ending approximately 4 weeks after hospital discharge. Measures of symptom burden (primary outcome), distress, health-related quality of life, and fatigue (secondary outcomes) will be administered in seven assessments coinciding with medically relevant time points from baseline and to a year post-intervention. Discussion The steady and continuing increase in use of stem cell transplantation has created growing need for efficacious, accessible interventions to reduce the short- and long-term negative physical and psychosocial effects of this challenging but potentially life-saving treatment. Expressive helping is a psychological intervention that was designed to fill this gap. It has been shown to be efficacious in long-term transplant survivors but could have even greater impact if it is capable of reducing symptoms during and soon after transplant. The WISE study will evaluate these benefits in a rigorous randomized controlled trial. Trial registration Clinicaltrial.govNCT03800758. Registered January 11, 2019
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Affiliation(s)
- Lauren Whitmore
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA.
| | - Taylor Schulte
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Katrin Bovbjerg
- Department of Medical Social Sciences, Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Madison Hartstein
- Department of Medical Social Sciences, Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Jane Austin
- Department of Psychology, William Paterson University, Wayne, NJ, USA
| | - George Luta
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Lily McFarland
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Scott D Rowley
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Themba Nyirenda
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Marquita Lewis-Thames
- Department of Medical Social Sciences, Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.,Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Annette L Stanton
- Departments of Psychology and Psychiatry/Biobehavioral Sciences and the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
| | - Heiddis Valdimarsdottir
- Department of Psychology, Reykjavik University, Reykjavik, Iceland.,Department of Oncological Sciences, Icahn School of Medicine at Sinai School, New York, NY, USA
| | - Kristi Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Christine Rini
- Department of Medical Social Sciences, Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
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Janicsák H, Ungvari GS, Gazdag G. Psychosocial aspects of hematopoietic stem cell transplantation. World J Transplant 2021; 11:263-276. [PMID: 34316451 PMCID: PMC8290998 DOI: 10.5500/wjt.v11.i7.263] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/18/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) has become a conventional and potentially curative treatment for various hematological diseases. As more sophisticated procedures have been developed and mortality rates have decreased, attention has shifted to the psychosocial challenges associated with transplantation. The psychosocial difficulties accompanying transplantation are addressed in the context of both quality of life (QOL) and psychopathological research. Among the psychiatric comorbidities of HSCT, anxiety, depression, sleep and sexual disorders, delirium and post-traumatic stress disorder are the most studied conditions. Recently, more attention has been focused on the psychosocial burden of caregivers. Devising recommendations for the management of psychiatric symptoms and psychosocial interventions in HSCT sufferers and close relatives is a major concern to consultation-liaison psychiatrists and transplant teams. This review synthesizes and critically evaluates the current literature on the psychosocial aspects of HSCT and appraises the clinical significance of these outcomes. Issues of QOL assessment; psychosocial functioning and QOL in the course of HSCT; impact of graft-versus-host disease and other predictors of QOL and psychosocial functioning; comorbid psychiatric disorders; and interventions to maintain or improve QOL and reduce psychopathology and psychosocial burden on family members are presented.
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Affiliation(s)
- Henrietta Janicsák
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Gabor S Ungvari
- Division of Psychiatry, University of Notre Dame, Fremantle 6009, Australia
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth 6009, Australia
| | - Gábor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
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10
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Yun SW, Greenberg J, Maxfield M. Preparation for Future Care Needs in Middle-Aged and Older Adults: What Promotes Feeling of Preparedness? Am J Hosp Palliat Care 2020; 38:972-978. [PMID: 33353403 DOI: 10.1177/1049909120981577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine whether demographic, dementia-related, and control-related variables predict preparation for future care needs (PFCN) in a sample of middle-aged and older adults. PFCN is defined in this study as a self-perceived sense of preparedness for one's own future care needs, including general awareness of future care needs, gathering relevant information, decision-making about care preferences, concrete planning, and non-avoidance of care planning. METHODS Participants (N = 122; age 40 to 88 years: M = 65.83, SD = 9.80) completed self-report measures in an in-person study. Hierarchical multiple regression was calculated to predict PFCN. RESULTS Being female, having more positive dementia attitudes, higher attribution to powerful others for health condition(s), and more completed end-of-life (EOL) planning significantly predicted greater PFCN. CONCLUSION Findings indicate a positive relationship between objective (completed EOL planning items) and subjective (PFCN) components of planning, thus highlighting the importance of taking concrete steps in EOL planning to yield greater feelings of preparedness, which has been associated with positive psychological outcomes.
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Affiliation(s)
- Stacy W Yun
- Department of Psychology, 14676University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Jeff Greenberg
- Department of Psychology, 8041University of Arizona, Tucson, AZ, USA
| | - Molly Maxfield
- Edson College of Nursing and Health Innovation, 7864Arizona State University, Phoenix, AZ, USA
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Banerjee R, Yi JC, Majhail NS, Jim HSL, Uberti J, Whalen V, Loren AW, Syrjala KL. Driving Distance and Patient-Reported Outcomes in Hematopoietic Cell Transplantation Survivors. Biol Blood Marrow Transplant 2020; 26:2132-2138. [PMID: 32781287 PMCID: PMC7414780 DOI: 10.1016/j.bbmt.2020.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/26/2020] [Accepted: 08/01/2020] [Indexed: 12/16/2022]
Abstract
Long driving distances to transplantation centers may impede access to care for hematopoietic cell transplantation (HCT) survivors. As a secondary analysis from the multicenter INSPIRE study (NCT01602211), we examined baseline data from relapse-free HCT adult survivors (2 to 10 years after allogeneic or autologous HCT) to investigate the association between driving distances and patient-reported outcome (PRO) measures of distress and physical function. We analyzed predictors of elevated distress and impaired physical function using logistic regression models that operationalized driving distance first as a continuous variable and separately as a dichotomous variable (<100 versus 100+ miles). Of 1136 patients available for analysis from 6 US centers, median driving distance was 82 miles and 44% resided 100+ miles away from their HCT centers. Elevated distress was reported by 32% of patients, impaired physical function by 19%, and both by 12%. Driving distance, whether operationalized as a continuous or dichotomous variable, had no impact on distress or physical function in linear regression modeling (95% confidence interval, 1.00 to 1.00, for both PROs with driving distance as a continuous variable). In contrast, chronic graft-versus-host-disease, lower income, and lack of Internet access independently predicted both elevated distress and impaired physical function. In summary, we found no impact of driving distance on distress and physical function among HCT survivors. Our results have implications for how long-term follow-up care is delivered after HCT, with regard to the negligible impact of driving distances on PROs and also the risk of a "digital divide" worsening outcomes among HCT survivors without Internet access.
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Affiliation(s)
- Rahul Banerjee
- Division of Oncology, Department of Medicine, University of California San Francisco, San Francisco, California.
| | - Jean C Yi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Heather S L Jim
- Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Joseph Uberti
- Division of Oncology, Karmanos Cancer Institute/Wayne State University School of Medicine, Detroit, Michigan
| | - Victoria Whalen
- Transplant Data Office, University of Nebraska Medical Center, Omaha, Nebraska
| | - Alison W Loren
- Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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12
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Quality of life and distress assessed with self and external assessment screening tools in patients with hematologic malignancies attending treatment in an acute hospital. Qual Life Res 2020; 29:3375-3385. [PMID: 32815114 PMCID: PMC7686164 DOI: 10.1007/s11136-020-02602-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 12/17/2022]
Abstract
Purpose In this study, we examined distress levels and quality of life (QoL) of patients with hematologic malignancies under treatment in an acute setting. We used external- and self-assessment instruments for distress. Additionally, we investigated the relation between distress and QoL as well as whether highly distressed patients differed from less distressed patients concerning their QoL. Methods A cross-sectional study with patients of the Medical Clinic II of the University Hospital Frankfurt was conducted. One hundred and nine patients were assessed with an expert rating scale and completed self-report questionnaires. Data were exploratively analyzed and group comparisons between patients who scored above the cut-off of the respective screening instruments and those who did not were conducted. Results Patients with hematologic malignancies experience high levels of distress and low QoL. Especially, role and social functioning are affected. Patients suffer most from fatigue, appetite loss, and insomnia. Using established cut-offs, all screening instruments were able to differentiate between patients regarding distress and QoL. Patients scoring above the cut-off were significantly more distressed and had a lower QoL. There was a medium-to-strong correlation between distress and QoL indicators. Conclusion Cancer-specific screening instruments seem to be able to identify treatment needs more specifically. They also allowed a better differentiation concerning QoL. The close link between distress and QoL needs to be recognized to enable a holistic approach to treatment and thereby optimize the quality of treatment.
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13
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Saunders IM, Tan M, Koura D, Young R. Long-term Follow-up of Hematopoietic Stem Cell Transplant Survivors: A Focus on Screening, Monitoring, and Therapeutics. Pharmacotherapy 2020; 40:808-841. [PMID: 32652612 DOI: 10.1002/phar.2443] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 01/19/2023]
Abstract
Annually, ~50,000 patients undergo hematopoietic stem cell transplantation (HCT) worldwide with almost 22,000 of these patients receiving HCT in the United States. HCT is a curative option for a wide range of hematologic malignancies, and advances in transplantation medicine have resulted in an increase in HCT survivors. It is anticipated that the number of HCT survivors will more than double from 242,000 in 2020 to ~500,000 in 2030. Survivors of HCT are at an increased risk of developing late complications due to exposure to chemotherapy and/or radiation in the pre-, peri-, and post-HCT phases and these cumulative exposures have the potential to damage normal tissue. This tissue damage leads to the early onset of chronic health conditions resulting in premature mortality in HCT survivors, who have a 15-year cumulative incidence of severe or life-threatening chronic health conditions exceeding 40%. Due to the significant burden of morbidity in HCT survivors and the delay in the development of long-term complications, this delicate patient population requires life-long monitoring due to the risk for neuropsychological, cardiac, pulmonary, renal, hepatic, ocular, skeletal, cardiac, endocrine, fertility, and sexual health complications, as well as secondary neoplasms. This review will focus on recent advances in screening, monitoring, and therapeutics for late-occurring or long-term complications in HCT survivors.
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Affiliation(s)
- Ila M Saunders
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, USA
| | - Marisela Tan
- Department of Pharmaceutical Services, San Francisco Medical Center, University of California, San Francisco, California, USA
| | - Divya Koura
- Division of Blood and Marrow Transplantation, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Rebecca Young
- Department of Pharmaceutical Services, San Francisco Medical Center, University of California, San Francisco, California, USA
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14
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The mediator role of unmet needs on quality of life in myeloma patients. Qual Life Res 2020; 29:2641-2650. [PMID: 32356277 DOI: 10.1007/s11136-020-02511-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The diagnosis of multiple myeloma (MM) has a significant impact on patients. This study analyzed the mediating role of patients' unmet needs in the relationship between psychological morbidity/social support and quality of life (QoL). METHODS This study included 213 patients with MM recruited from the outpatient medical oncology and clinical hematology services from five hospitals. Patients who meet the study criteria were referred by physicians and invited to participate in the study by the researcher. All participants answered the following questionnaires: Hospital Anxiety and Depression Scale, Satisfaction with Social Support Scale, Short-Form Survivor Unmet Needs Survey, and The European Organization for Research and Treatment of Cancer's Multiple Myeloma Module. Descriptive statistics, bivariate correlations, and structural equation modeling were performed to analyze the data. RESULTS The indirect effect of psychological morbidity on patients' future perspectives (MYFP) was partially mediated by information unmet needs (INF), while the indirect effect of psychological morbidity on treatment side effects (MYSE) was partially mediated by relationship and emotional unmet needs (REH). In turn, the indirect effect of psychological morbidity on disease symptoms (MYDS) was fully mediated by REH. Social support had an indirect effect on MYDS and MYSE fully mediated by REH. CONCLUSION Intervention programs tailored to promote MM patients' QoL should specifically address information and emotional needs, raising awareness and training health professionals, caregivers, and family members to attend MM patients' unmet needs.
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15
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Longitudinal associations between coping strategies, locus of control and health-related quality of life in patients with breast cancer or melanoma. Qual Life Res 2020; 29:1271-1279. [PMID: 31894505 DOI: 10.1007/s11136-019-02401-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2019] [Indexed: 11/12/2022]
Abstract
PURPOSE A diagnosis of breast cancer or melanoma is a traumatic life event that patients have to face. However, their locus-of-control (LOC) beliefs and coping strategies as well as the associations with health-related quality of life (HRQoL) changes over time are still not well known and rarely compared by cancer site. METHODS The objective of this longitudinal study was to assess the association of LOC (Cancer Locus-of-Control Scale) and coping (Brief Cope) changes, with change in HRQoL (EORTC QLQ-C30) over time in newly diagnosed breast cancer and melanoma patients at 1, 6, 12, and 24 month post-diagnosis. Mixed models were used to compare LOC and coping longitudinal changes as well as their associations with HRQoL changes in early-stage breast cancer and melanoma patients. RESULTS Overall, 215 breast cancer and 78 melanoma patients participated in the study. At baseline, HRQoL levels were often higher for breast cancer compared to melanoma patients. For breast cancer and melanoma patients, negative coping strategies and perceived control over the course of illness were negatively and positively associated with HRQoL changes, respectively. For breast cancer patients only, emotional coping and internal causal attribution were negatively associated with HRQoL changes. For both cancer sites, living with a partner correlated with worse HRQoL. CONCLUSIONS Understanding coping strategies and LOC beliefs used by patients soon after their cancer diagnosis and over the course of illness can help identifying psychological and supportive care to modify maladaptive thoughts and beliefs and promote more adaptive behaviors to ultimately improve patients' well-being and HRQoL.
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16
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Yildiz Kabak V, Cetinkaya DU, Kuskonmaz B, Cetin N, Duger T. Effects of multimodal exercise on clinical status and patient-reported outcomes in children undergoing hematopoietic stem cell transplantation. Pediatr Hematol Oncol 2019; 36:410-421. [PMID: 31530206 DOI: 10.1080/08880018.2019.1648619] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
There are limited data available regarding effectiveness of exercise training in children undergoing hematopoietic stem cell transplantation (HSCT). We aimed to investigate effects of multimodal exercise program on clinical status and patient-reported outcomes including pain, fatigue, depression, and quality of life (QOL) level of children and their parents' QOL level. Twenty-six children undergoing HSCT participated in this study. Clinical status, pain, fatigue, depression, and QOL level of children were assessed three times: before HSCT, at discharge, and one month later. For intervention group (IG, n = 15), multimodal exercise program was performed five days a week, throughout hospitalization and children were advised to continue exercise program at home. For control group (CG, n = 11), being active as much as possible was advised. The number of painful day and pain intensity was significantly lower in IG than in CG during hospitalization (p < .05). Depression level decreased in IG at the time points (p ˂ .05); however, there was no significantly difference between groups. The QOL level was higher in IG than CG only at control measurements (p ˂ .05). In addition, QOL level of the parents decreased in both groups (p ˂ .05). There was no statistically difference between groups in terms of other clinical variables. The multimodal supervised exercise program has positive effects on children's pain and QOL level. Exercise program was also well tolerated by children during hospitalization. In addition, QOL levels of the parents were also negatively affected during hospitalization, and interventions aiming to increase QOL level of the parents should be considered.
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Affiliation(s)
- Vesile Yildiz Kabak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University , Ankara , Turkey
| | - Duygu Uckan Cetinkaya
- Faculty of Medicine, Department of Pediatrics, Division of Bone Marrow Transplantation Unit, Hacettepe University , Ankara , Turkey
| | - Baris Kuskonmaz
- Faculty of Medicine, Department of Pediatrics, Division of Bone Marrow Transplantation Unit, Hacettepe University , Ankara , Turkey
| | - Nevin Cetin
- Ihsan Dogramaci Children Hospital, Hacettepe University , Ankara , Turkey
| | - Tulin Duger
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University , Ankara , Turkey
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17
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Comparison of quality of life and health behaviors in survivors of acute leukemia and the general population. Ann Hematol 2019; 98:2357-2366. [PMID: 31338572 DOI: 10.1007/s00277-019-03760-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022]
Abstract
We aimed to compare the health-related quality of life and health behaviors of acute leukemia (AL) survivors with that of the general population from two cohorts. AL survivors (n = 149) completed a set of questionnaires to evaluate quality of life, mental status, and health behaviors. AL survivors had more physical and mental difficulties (problems with usual activities, 15% vs. 5%, p < 0.001; anxiety or depression, 24% vs. 9%, p < 0.001; pain, 35% vs. 20%, p = 0.002) and more financial difficulties (p < 0.001) than the general population. Survivors who received stem cell transplantation (SCT) had significantly worse problems with role functioning, fatigue, pain, dyspnea, and insomnia, and had higher depression scores than chemotherapy group (p = 0.024). In terms of health behaviors, AL survivors had lower rates of smoking and drinking and higher influenza vaccination rates than the general population. However, only 17% of survivors had been recommended to receive screening for other cancers from health-care providers, and 67% thought their risk for other cancers was equal or lower than that of the general population. Cancer screening rates were even lower in the SCT group than in the chemotherapy group (p = 0.041). Our study indicates that clinicians should establish more appropriate survivorship care plans.
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Balck F, Zschieschang A, Zimmermann A, Ordemann R. A randomized controlled trial of problem-solving training (PST) for hematopoietic stem cell transplant (HSCT) patients: Effects on anxiety, depression, distress, coping and pain. J Psychosoc Oncol 2019; 37:541-556. [PMID: 31304890 DOI: 10.1080/07347332.2019.1624673] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The effect of problem-solving training (PST) on psychological distress, coping, pain, overall distress, and problem-solving behavior in hematopoietic stem cell transplant (HSCT) patients was investigated in a randomized controlled trial. The intervention was performed during aplasia and included five 1-hour individual sessions; it was started 2 days before HSCT. Forty-five patients were included in the intervention group (IG) and 46 in the control group (CG). The effects were measured at 11 (t2) and 21 days (t3) after HSCT. At t2, 31 patients remained in the IG and 36 patients in the CG. Patients > 18 years, with adequate cognitive performance, and with adequate command of the German language, were included. They were assessed with regard to anxiety and depression (Hospital Anxiety and Depression Scale), psychological distress (Symptom Checklist short version-9), coping (Brief Cope), problem-solving (Social Problem Solving Inventory-Revised), pain (Questions of Pain), and distress (National Comprehensive Cancer Network Distress Thermometer). The data were analyzed using analyses of covariance (general linear model) to examine the differences between the two conditions. Anxiety, psychological distress, pain, and general stress were reduced after PST in the IG compared with those in the CG. Active coping was reinforced in the IG. The IG patients were also better able to reduce negative problem orientation and improve problem implementation. The effect of the PST on these features was between Eta 2 =.13 and .45 and can thus be described as medium to strong. There were no changes in depression and social support. After careful interpretation of the results, it can be said that PST affects patients' mental health, problem-solving, and coping. Because these psychological changes occur shortly after the transplantation in the phase of aplasia, HSCT patients are likely to be given a more favorable starting position for the course of recovery.
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Affiliation(s)
- Friedrich Balck
- Psychosocial Medicine and Developmental Neuroscience, Medical University Hospital Carl Gustav Carus, TU-Dresden , Dresden , Germany
| | - Anja Zschieschang
- Saxon State Chamber of Physicians, State Coordination Office for Medical Child Protection , Dresden , Germany
| | - Anja Zimmermann
- Medicine didactics Center Leipzig, LernKlinik Leipzig, University Leipzig , Leipzig , Germany
| | - Rainer Ordemann
- Medical Clinic I, Medical University Hospital Carl Gustav Carus, TU-Dresden , Dresden , Germany
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Graça Pereira M, Ferreira G, Pereira M, Faria S, Bacalhau R, Monteiro S, Fernandes B, Vilaça M. Validation of the Quality of Life Multiple Myeloma Module Questionnaire (QLQ‐MY20) in Portuguese myeloma patients. Eur J Cancer Care (Engl) 2019; 28:e13128. [DOI: 10.1111/ecc.13128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 01/22/2023]
Affiliation(s)
- M. Graça Pereira
- School of Psychology University of Minho Braga Portugal
- Psychology Research Center (CIPsi) University of Minho Braga Portugal
| | - Gabriela Ferreira
- School of Psychology University of Minho Braga Portugal
- Psychology Research Center (CIPsi) University of Minho Braga Portugal
| | - Marta Pereira
- School of Psychology University of Minho Braga Portugal
- Psychology Research Center (CIPsi) University of Minho Braga Portugal
| | - Sara Faria
- School of Psychology University of Minho Braga Portugal
| | - Rosário Bacalhau
- Portuguese Institute of Oncology Francisco Gentil Lisboa Portugal
| | - Sara Monteiro
- Department of Education and Psychology University of Aveiro Aveiro Portugal
- Center for Health Technology and Services Research (CINTESIS) University of Porto Porto Portugal
| | - Bruna Fernandes
- Department of Education and Psychology University of Aveiro Aveiro Portugal
| | - Margarida Vilaça
- Psychology Research Center (CIPsi) University of Minho Braga Portugal
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Knips L, Bergenthal N, Streckmann F, Monsef I, Elter T, Skoetz N. Aerobic physical exercise for adult patients with haematological malignancies. Cochrane Database Syst Rev 2019; 1:CD009075. [PMID: 30702150 PMCID: PMC6354325 DOI: 10.1002/14651858.cd009075.pub3] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although people with haematological malignancies have to endure long phases of therapy and immobility, which is known to diminish their physical performance level, the advice to rest and avoid intensive exercises is still common practice. This recommendation is partly due to the severe anaemia and thrombocytopenia from which many patients suffer. The inability to perform activities of daily living restricts them, diminishes their quality of life and can influence medical therapy. OBJECTIVES In this update of the original review (published in 2014) our main objective was to re-evaluate the efficacy, safety and feasibility of aerobic physical exercise for adults suffering from haematological malignancies considering the current state of knowledge. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2018, Issue 7) and MEDLINE (1950 to July 2018) trials registries (ISRCTN, EU clinical trials register and clinicaltrials.gov) and conference proceedings. We did not apply any language restrictions. Two review authors independently screened search results, disagreements were solved by discussion. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing an aerobic physical exercise intervention, intending to improve the oxygen system, in addition to standard care with standard care only for adults suffering from haematological malignancies. We also included studies that evaluated aerobic exercise in addition to strength training. We excluded studies that investigated the effect of training programmes that were composed of yoga, tai chi chuan, qigong or similar types of exercise. We also excluded studies exploring the influence of strength training without additive aerobic exercise as well as studies assessing outcomes without any clinical impact. DATA COLLECTION AND ANALYSIS Two review authors independently screened search results, extracted data and assessed the quality of trials. We used risk ratios (RRs) for adverse events, mortality and 100-day survival, standardised mean differences (SMD) for quality of life (QoL), fatigue, and physical performance, and mean differences (MD) for anthropometric measurements. MAIN RESULTS In this update, nine trials could be added to the nine trials of the first version of the review, thus we included eighteen RCTs involving 1892 participants. Two of these studies (65 participants) did not provide data for our key outcomes (they analysed laboratory values only) and one study (40 patients) could not be included in the meta-analyses, as results were presented as changes scores only and not as endpoint scores. One trial (17 patients) did not report standard errors and could also not be included in meta-analyses. The overall potential risk of bias in the included trials is unclear, due to poor reporting.The majority of participants suffered from acute lymphoblastic leukaemia (ALL), acute myeloid leukaemia (AML), malignant lymphoma and multiple myeloma, and eight trials randomised people receiving stem cell transplantation. Mostly, the exercise intervention consisted of various walking intervention programmes with different duration and intensity levels.Our primary endpoint overall survival (OS) was only reported in one of these studies. The study authors found no evidence for a difference between both arms (RR = 0.67; P = 0.112). Six trials (one trial with four arms, analysed as two sub-studies) reported numbers of deceased participants during the course of the study or during the first 100 to 180 days. For the outcome mortality, there is no evidence for a difference between participants exercising and those in the control group (RR 1.10; 95% CI 0.79 to 1.52; P = 0.59; 1172 participants, low-certainty evidence).For the following outcomes, higher numbers indicate better outcomes, with 1 being the best result for the standardised mean differences. Eight studies analysed the influence of exercise intervention on QoL. It remains unclear, whether physical exercise improves QoL (SMD 0.11; 95% CI -0.03 to 0.24; 1259 participants, low-certainty evidence). There is also no evidence for a difference for the subscales physical functioning (SMD 0.15; 95% CI -0.01 to 0.32; 8 trials, 1329 participants, low-certainty evidence) and anxiety (SMD 0.03; 95% CI -0.30 to 0.36; 6 trials, 445 participants, very low-certainty evidence). Depression might slightly be improved by exercising (SMD 0.19; 95% CI 0.0 to 0.38; 6 trials, 445 participants, low-certainty evidence). There is moderate-certainty evidence that exercise probably improves fatigue (SMD 0.31; 95% CI 0.13 to 0.48; 9 trials, 826 patients).Six trials (435 participants) investigated serious adverse events. We are very uncertain, whether additional exercise leads to more serious adverse events (RR 1.39; 95% CI 0.94 to 2.06), based on very low-certainty evidence.In addition, we are aware of four ongoing trials. However, none of these trials stated, how many patients they will recruit and when the studies will be completed, thus, potential influence of these trials for the current analyses remains unclear. AUTHORS' CONCLUSIONS Eighteen, mostly small RCTs did not identify evidence for a difference in terms of mortality. Physical exercise added to standard care might improve fatigue and depression. Currently, there is inconclusive evidence regarding QoL, physical functioning, anxiety and SAEs .We need further trials with more participants and longer follow-up periods to evaluate the effects of exercise intervention for people suffering from haematological malignancies. To enhance comparability of study data, development and implementation of core sets of measuring devices would be helpful.
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Affiliation(s)
- Linus Knips
- Cochrane Haematological Malignancies Group, Department I of Internal Medicine, University Hospital of Cologne, Kerpener Str. 62, Cologne, Germany
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Chakraborty R, Sidana S, Shah GL, Scordo M, Hamilton BK, Majhail NS. Patient-Reported Outcomes with Chimeric Antigen Receptor T Cell Therapy: Challenges and Opportunities. Biol Blood Marrow Transplant 2018; 25:e155-e162. [PMID: 30500439 DOI: 10.1016/j.bbmt.2018.11.025] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/21/2018] [Indexed: 12/16/2022]
Abstract
Patient-reported outcomes (PROs) are an important tool to assess the impact of a new therapy on symptom burden and health-related quality of life (HRQoL). Chimeric antigen receptor T (CAR-T) cell therapies have been approved for use in relapsed or refractory leukemia and lymphoma based on promising efficacy in clinical trials. However, data are lacking on patient-reported toxicity and impact on HRQoL. This review provides an overview of the incorporation of PROs in CAR-T cell therapy and the specific challenges in this context. The first step is to demonstrate feasibility of PRO monitoring in the acute phase after CAR-T cell infusion. Apart from core PRO domains like physical functioning, disease-related symptoms, and symptomatic adverse effects, important measures to consider are cognitive functioning and financial toxicity. Because there are no validated PRO instruments in the setting of CAR-T cell therapy, universally validated measures like Patient-Reported Outcomes Measurement Information System (PROMIS) could be considered, which is also recommended in the setting of hematopoietic stem cell transplantation. Given the timeline of toxicities with CAR-T cell therapy, PRO instruments should be administered at baseline and at least weekly in the first 30 days. Subsequently, frequent monitoring of PROs in the first year might be helpful in identifying short- and intermediate-term toxicities, functional limitations, and neuropsychiatric effects. The major potential challenge in acute phase would be missing data when patients develop severe cytokine release syndrome or neurotoxicity. Designing a strategy for handling missing data is crucial. The long-term safety of CAR-T cell therapy is not well characterized because of short follow-up in most studies reported thus far. PROs should be measured at least yearly after the first year to identify potential late effects like cognitive deficit or autoimmune manifestations. Collaboration between institutions performing cellular therapy and engagement with patients, clinicians, and statisticians with expertise in PROs are crucial for setting a comprehensive agenda on integration of PROs with CAR-T cell therapy.
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Affiliation(s)
| | - Surbhi Sidana
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Gunjan L Shah
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York
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Valdimarsdottir HB, Figueiro MG, Holden W, Lutgendorf S, Wu LM, Ancoli‐Israel S, Chen J, Hoffman‐Peterson A, Granski J, Prescott N, Vega A, Stern N, Winkel G, Redd WH. Programmed environmental illumination during autologous stem cell transplantation hospitalization for the treatment of multiple myeloma reduces severity of depression: A preliminary randomized controlled trial. Cancer Med 2018; 7:4345-4353. [PMID: 30099857 PMCID: PMC6144249 DOI: 10.1002/cam4.1690] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 05/31/2018] [Accepted: 06/16/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Over a third of multiple myeloma (MM) patients report clinical levels of depression during autologous stem cell transplant (ASCT) hospitalization. We report preliminary results from a randomized clinical trial investigating the effect of Programmed Environmental Illumination (PEI) of hospital rooms on depression. METHODS Patients (N = 187) scheduled to receive an ASCT were assessed for eligibility. Those who met study eligibility criteria (n = 44) were randomly assigned to one of two PEI conditions involving delivery of either circadian active bright white light (BWL) or circadian inactive dim white light (DWL) throughout the room from 7 to 10 am daily during hospitalization. Patients completed the Center for Epidemiological Studies Depression Scale (CES-D) prior to hospitalization, at days 2 and 7 post-transplant, and on the third day of engraftment. RESULTS General linear model analyses revealed no difference between the groups in CES-D total score at baseline (P = 0.7859). A longitudinal linear mixed model analysis revealed a significant interaction between time of assessment and light condition [F(3,107) = 2.90; P = 0.0386; ɳ2 = 0.08)], indicating that PEI prevented the development of depression during hospitalization, with effects reaching significance by the third day of engraftment. At the third day of engraftment, 68.4% of the participants in the DWL comparison condition met the criteria for clinically significant depression compared to 42.1% in the BWL condition. CONCLUSION These findings demonstrate that PEI using BWL during MM ASCT hospitalization is effective in reducing the development of depression. Future studies should examine the mechanisms whereby PEI improves depression.
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Affiliation(s)
- Heiðdís B. Valdimarsdottir
- PsychologyReykjavik UniversityReykjavikIceland
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
| | | | - William Holden
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
| | - Susan Lutgendorf
- Departments of Psychology and Brain Sciences, Obstetrics and Gynecology, and UrologyUniversity of Iowa College of Liberal Arts and SciencesIowa CityIowa
| | - Lisa M. Wu
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinois
| | - Sonia Ancoli‐Israel
- Department of PsychiatryUniversity of California San DiegoLa JollaCalifornia
| | - Jason Chen
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
| | - Ariella Hoffman‐Peterson
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
| | - Julia Granski
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
| | - Nina Prescott
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
| | - Alejandro Vega
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
| | - Natalie Stern
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
| | - Gary Winkel
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
| | - William H. Redd
- Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew York CityNew York
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Temporal trajectory of quality of life and its predictors in recipients of hematopoietic stem cell transplantation. Ann Hematol 2018; 97:1407-1415. [DOI: 10.1007/s00277-018-3319-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/23/2018] [Indexed: 01/21/2023]
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24
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Gonzales MJ, Gross DM, Cooke E. Psychosocial Aspects of Hematologic Disorders. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00090-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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25
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Oberoi DV, White VM, Seymour JF, Prince HM, Harrison S, Jefford M, Winship I, Hill DJ, Bolton D, Millar J, Wong Doo N, Kay A, Giles G. Distress and unmet needs during treatment and quality of life in early cancer survivorship: A longitudinal study of haematological cancer patients. Eur J Haematol 2017; 99:423-430. [DOI: 10.1111/ejh.12941] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2017] [Indexed: 01/22/2023]
Affiliation(s)
| | - Victoria M. White
- Cancer Council Victoria; Melbourne Vic. Australia
- Deakin University; Burwood Vic. Australia
| | - John F. Seymour
- The University of Melbourne; Parkville Vic. Australia
- Peter MacCallum Cancer Centre; Melbourne Vic. Australia
| | - H. Miles Prince
- The University of Melbourne; Parkville Vic. Australia
- Peter MacCallum Cancer Centre; Melbourne Vic. Australia
| | - Simon Harrison
- The University of Melbourne; Parkville Vic. Australia
- Peter MacCallum Cancer Centre; Melbourne Vic. Australia
| | - Michael Jefford
- The University of Melbourne; Parkville Vic. Australia
- Peter MacCallum Cancer Centre; Melbourne Vic. Australia
| | | | - David J. Hill
- Cancer Council Victoria; Melbourne Vic. Australia
- The University of Melbourne; Parkville Vic. Australia
| | | | | | | | - Anne Kay
- North Eastern Melbourne Integrated Cancer Service; Heidelberg Vic. Australia
| | - Graham Giles
- Cancer Council Victoria; Melbourne Vic. Australia
- The University of Melbourne; Parkville Vic. Australia
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Magyari F, Kósa K, Berecz R, Illés A, Miltényi Z, Simon Z, Illés Á. Employment status and health related quality of life among Hodgkin-lymphoma survivors'- results based on data from a major treatment center in Hungary. Health Qual Life Outcomes 2017; 15:180. [PMID: 28927453 PMCID: PMC5605984 DOI: 10.1186/s12955-017-0758-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 09/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to risk and response adapted treatment strategies, more than 80% of newly diagnosed classical Hodgkin lymphoma (HL) patients can be cured, and become long-term survivors. However, a high proportion of survivors suffer from treatment-related long-term side effects such as secondary malignancy, organ failure, persistent fatigue and psychological distress. The aim of this study was to evaluate psychological distress and its risk factors among our HL survivors. METHODS One hundred sixty-three (50% female) adult HL survivors were contacted between January 1, 2012 and march 31, 2015 in our outpatient centre. The patients were asked to complete a standardized, validated, self-administered Hungarian questionnaire with demographic questions and the following scales: Hospital anxiety and depression scale (HADS14), general health questionnaire (GHQ12), sense of coherence (SOC13) perceived stress scale (PSS4), dysfunctional attitude scale (DAS17). Disease and treatment data were acquired from hospital records. RESULTS Majority of HL survivors are in early adulthood, our most important goal should be to return them to normal life after their lymphoma is cured. The employment status at the time of survey seemed to be crucial so patients were divided into either active (n = 93) or inactive (n = 47) group. Retired survivors (n = 19) were excluded from the subgroup analysis. Psychological distress was significantly lower in active patients. Multiple logistic regression analysis showed significant differences between the inactive and active subgroups, such as age at diagnosis (≥30 years or below, p = 0.001), education level (below college vs. college, p = 0.032) and treatment related long-term side effects (yes vs. no, p < 0.001). Predictors for treatment-related long-term side effects are female gender (p = 0.011), chemotherapy protocol (ABVD vs. other, p < 0.001). CONCLUSIONS Our data suggest that employment status and treatment-related long-term side effects play a critical role in the health related quality of life outcome among Hungarian HL survivors.
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Affiliation(s)
- Ferenc Magyari
- Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - Karolina Kósa
- Department of Behavioural Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Roland Berecz
- Department of Psychiatry, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Anna Illés
- Department of Anaesthesiology and Intensive Care Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsófia Miltényi
- Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsófia Simon
- Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Árpád Illés
- Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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27
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Depression and anxiety following hematopoietic stem cell transplantation: a prospective population-based study in Germany. Bone Marrow Transplant 2017; 52:1651-1657. [PMID: 28892083 DOI: 10.1038/bmt.2017.190] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/06/2017] [Accepted: 07/29/2017] [Indexed: 01/11/2023]
Abstract
In this prospective multicenter study, we investigated the course of depression and anxiety during hematopoietic stem cell transplantation (HSCT) until 5 years after transplantation adjusting for medical information. Patients were consulted before HSCT (n=239), at 3 months (n=150), 12 months (n=102) and 5 years (n=45) after HSCT. Depression and anxiety were assessed with the Hospital Anxiety and Depression Scale (HADS). Detailed medical and demographic information was collected. Prevalence rates were compared with an age- and gender-matched control group drawn from a large representative sample (n=4110). The risk of depression before HSCT was lower for patients than for the control group (risk ratio (RR), 0.56; 95% confidence interval (CI), 0.39/0.81). Prevalence rates of depression increased from 12 to 30% until 5 years post HSCT. Anxiety rates were most frequently increased before HSCT (29%, RR, 1.31; 95% CI, 1.02/1.68) and then reached a stable level comparable to the background population (RR 0.83, 95% CI, 0.56/1.22). This study confirms the low levels of depression in the short term after HSCT and identifies depression as a long-term effect. Furthermore, it confirms previous results of heightened anxiety before HSCT. Surveillance of symptoms of anxiety during the short-term phase of HSCT and of depression during the following years is crucial.
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28
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Penalba V, Asvat Y, Deshields TL, Vanderlan JR, Chol N. Rates and predictors of psychotherapy utilization after psychosocial evaluation for stem cell transplant. Psychooncology 2017; 27:427-433. [DOI: 10.1002/pon.4473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 04/27/2017] [Accepted: 06/02/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Valentina Penalba
- Siteman Cancer Center, Barnes-Jewish Hospital; Washington University School of Medicine; Saint Louis Missouri USA
| | - Yasmin Asvat
- Siteman Cancer Center, Barnes-Jewish Hospital; Washington University School of Medicine; Saint Louis Missouri USA
| | - Teresa L. Deshields
- Siteman Cancer Center, Barnes-Jewish Hospital; Washington University School of Medicine; Saint Louis Missouri USA
| | - Jessica R. Vanderlan
- Siteman Cancer Center, Barnes-Jewish Hospital; Washington University School of Medicine; Saint Louis Missouri USA
| | - Nyadow Chol
- Siteman Cancer Center, Barnes-Jewish Hospital; Washington University School of Medicine; Saint Louis Missouri USA
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29
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PROSE Treatment for Ocular Chronic Graft-Versus-Host Disease as a Clinical Network Expands. Eye Contact Lens 2017; 42:262-6. [PMID: 26448446 DOI: 10.1097/icl.0000000000000186] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Keratoconjunctivitis sicca occurs in 40% to 90% of patients with ocular chronic graft-versus-host disease (cGVHD). Ocular symptoms can have profound effects in both the visual function and quality of life of patients with GVHD. We report the impact of prosthetic replacement of the ocular surface ecosystem (PROSE) treatment in patients with cGVHD as a clinical network expands. METHODS We queried the BostonSight PROSE manufacturing database from January 2002 to December 2011. Patients treated for ocular cGVHD were reported by age, gender, year, and network site where the treatment was undertaken. The baseline and six-month follow-up scores of visual function using a standardized validated instrument, the National Eye Institute Visual Function Questionnaire (NEI VFQ-25), were evaluated for a period in 2006 and again in 2010 after network expansion had occurred. RESULTS A total of 407 patients with a male:female ratio of 226:181, mean age was 51 years with ocular cGVHD underwent PROSE treatment from January 2002 to December 2011. By 2011, 67% of all cases were treated at network clinics. Baseline characteristics of patients treated throughout the network in 2010 were similar to that of 2006 and 2010 cohorts from the main center. There was a significant improvement of 41 points (P<0.001) in composite NEI VFQ score among patients treated across the network in 2010, similar to the improvement of 30 points (P<0.001) seen among the patients treated at the main center in 2010. There was a trend toward lower baseline self-reported general health status (SRGHS) and VFQ scores among patients treated at network clinics, suggesting that expansion of the network allows treatment of sicker patients (lower general health status) or those more severely affected by ocular cGVHD. CONCLUSIONS PROSE treatment of ocular cGVHD has increased in the last decade with the establishment of BostonSight network clinics across the United States. Patients treated at network clinics showed similar levels of baseline visual function and SRGHS, and achieved a similar high level of improvement in visual function as those treated at the main center. Patient-reported measures of functional status are useful in evaluating treatment options for patients with cGVHD. PROSE treatment has significant positive impact on the visual function of patients with ocular cGVHD regardless of whether the patient is treated at the main center or at a network site.
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Locus of control, quality of life, anxiety, and depression among Malaysian breast cancer patients: The mediating role of uncertainty. Eur J Oncol Nurs 2017; 27:28-35. [PMID: 28279393 DOI: 10.1016/j.ejon.2017.01.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 01/31/2017] [Accepted: 01/31/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE The main objective of this study was to investigate the mediating role of uncertainty in the relationship between locus of control with quality of life, anxiety, and depression. METHODS A descriptive and correlational survey was conducted in a private hospital in Kuala Lumpur, Malaysia. A convenience sample of 118 Malaysian breast cancer patients voluntarily participated in the study and responded to a set of questionnaires including: socio-demographic questionnaire, the short form of Locus of Control Scale, the Functional Assessment of Cancer Therapy-Breast (FACT-B), the Hospital Anxiety and Depression Scale (HADS), and the Short-Form Mishel Uncertainty in Illness Scale (SF-MUIS). RESULTS The results revealed that breast cancer patients with higher internal locus of control and lower external locus of control experience a higher quality of life, lower anxiety, and lower depression. Also, uncertainty mediated the relationship between locus of control with quality of life and depression (quasi-significant). CONCLUSIONS The findings indicated the need for early, targeted psychological interventions seeking to gradually shift cancer patients' locus of control from external to internal in order to improve their quality of life and reduce their depression and anxiety. Moreover, health care providers by providing relevant information to cancer patients, especially for externally oriented patients, can reduce their uncertainty which in turn would improve their quality of life.
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31
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Nothing left to chance? The impact of locus of control on physical and mental quality of life in terminal cancer patients. Support Care Cancer 2017; 25:1985-1991. [PMID: 28175997 DOI: 10.1007/s00520-017-3605-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study is to evaluate if locus of control (LOC) predicts various quality of life (QOL) and mental well-being measures among terminally ill cancer patients at the time of palliative care consult. METHODS Multi-site analysis of patients with advanced cancer being seen as new patients in a Palliative and Supportive Care outpatient clinic. Patients completed the following surveys: locus of control (LOC) scale, Functional Assessment of Chronic Illness Therapy-General (FACT-G), Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp), Hospital Anxiety Depression Scale (HADS), and Herth Hope Index (HHI). Regression models were created to examine the effect of LOC upon QOL, symptoms, and other measures of mental well-being. These models adjusted for the effect of age, gender, race, partnership status, education, and months since diagnosis as potential confounders. RESULTS This study enrolled 100 patients. After adjusting for site, race, and partnership status, higher levels of LOC chance predicted decreased QOL (FACT-G) (p < 0.01). Higher levels of LOC chance also correlated with increased depression and anxiety (p ≤ 0.01) and decreased meaning/peace and faith (p ≤ 0.01). Additionally, higher levels of LOC chance predicted decreased hope (HHI) (p ≤ 0.001). CONCLUSIONS Terminally ill cancer patients with a high LOC chance may be at risk for decreased physical and mental well-being at the end of life. Efforts should be made to identify these patients and design interventions to increase their feeling of control over the situation in order to improve physical and mental well-being at the end of life.
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Alawi EM, Mathiak KA, Panse J, Mathiak K. Health-related quality of life in patients with indolent and aggressive non-Hodgkin lymphoma. COGENT PSYCHOLOGY 2016. [DOI: 10.1080/23311908.2016.1169582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Eliza M. Alawi
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, RWTH Aachen University, Pauwelsstr. 30, Aachen 52074, Germany
- Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany
| | - Krystyna A. Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, RWTH Aachen University, Pauwelsstr. 30, Aachen 52074, Germany
- Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Jens Panse
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation Medical, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital Aachen, RWTH Aachen University, Pauwelsstr. 30, Aachen 52074, Germany
- Jülich-Aachen Research Alliance (JARA)-Translational Brain Medicine, Jülich, Aachen, Germany
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Jim HSL, Sutton SK, Small BJ, Jacobsen PB, Wood WA, Knight JM, Majhail NS, Syrjala KL, Lee SJ. Trajectories of Quality of Life after Hematopoietic Cell Transplantation: Secondary Analysis of Blood and Marrow Transplant Clinical Trials Network 0902 Data. Biol Blood Marrow Transplant 2016; 22:2077-2083. [PMID: 27538374 DOI: 10.1016/j.bbmt.2016.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/11/2016] [Indexed: 01/12/2023]
Abstract
Quality of life is increasingly recognized as an important secondary endpoint of hematopoietic cell transplantation (HCT). The current study examined the extent to which attrition results in biased estimates of patient quality of life. The study also examined whether patients differ in terms of trajectories of quality of life in the first 6 months after transplantation. A secondary data analysis was conducted of 701 participants who enrolled in the Blood and Marrow Transplantation Clinical Trials Network 0902 trial. Participants completed the Medical Outcomes Study Short Form 36, a measure of quality of life, before undergoing transplantation and again 100 days and 180 days after transplantation. Results indicated that attrition resulted in slightly biased overestimates of quality of life but the amount of overestimation remained stable over time. Patients could be grouped into 3 distinct classes based on physical quality of life: (1) low and stable; (2) average and declining, then stable; and (3) average and stable. Four classes of patients emerged for mental quality of life: (1) low and stable; (2) average, improving, then stable; (3) higher than average (by almost 1 SD) and stable; and (4) average and stable. Taken together, these data provide a more comprehensive understanding of quality of life that can be used to educate HCT recipients and their caregivers.
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Affiliation(s)
- Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida.
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Brent J Small
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida; School of Aging Studies, University of South Florida, Tampa, Florida
| | - Paul B Jacobsen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - William A Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Jennifer M Knight
- Departments of Psychiatry and Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchison Cancer Research Center, Seattle, Washington
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchison Cancer Research Center, Seattle, Washington
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Cetingok M, Hathaway DK, Winsett RR. Differences in Quality of Life before Transplantation among Transplant Recipients with Respect to Selected Socioeconomic Variables. Prog Transplant 2016; 15:338-44. [PMID: 16477816 DOI: 10.1177/152692480501500405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To examine differences in quality of life before transplantation among transplant recipients with respect to a selected set of socioeconomic variables related to household/housing, family social and health history, and availability and use of community resources. Methods An exploratory-descriptive study in a US university's transplant clinic. Sample included 249 kidney, liver, and pancreas transplant recipients aged 18 years or older. Instruments were a socioeconomic data questionnaire, the Sickness Impact Profile, the Adult Self-Image Scale, the Quality of Life Index, and a general quality of life scale. Descriptive statistics and analysis of variance with Bonferroni adjustment were used with a significance level of .05. Effect sizes were estimated. Results Quality of life did not differ significantly for any variable except for the use of private insurance combined with public health insurance. Such coverage was associated with significantly better scores on the psychosocial and total dimensions of the Sickness Impact Profile, indicating better health before transplantation. Conclusion Researchers must first explore why a mix of private and public health insurance is associated with a higher quality of life and second reexamine whether these results occur at other transplant centers. These results also provide direction for social work professionals as they counsel patients in an attempt to help patients achieve a better psychosocial and physical quality of life before transplantation.
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Affiliation(s)
- Muammer Cetingok
- University of Tennessee, College of Social Work, Memphis 38163, USA
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Papadopoulou C, Johnston B, Themessl-Huber M. Decay, Transformation, and Growth: Meaning-Making Processes of Patients With Acute Leukemia Within the First Year After Diagnosis or Relapse. Oncol Nurs Forum 2016; 43:E73-81. [PMID: 26906141 DOI: 10.1188/16.onf.e73-e81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To explore the processes through which patients construct their meanings of acute leukemia (AL).
RESEARCH APPROACH An exploratory design was employed using serial, in-depth interviews, guided by Smith's Interpretative Phenomenological Analysis approach.
SETTING Two inpatient hematology clinics in the United Kingdom.
PARTICIPANTS 10 adult patients with AL.
METHODOLOGIC APPROACH Two serial interviews were conducted with each participant, two to four weeks apart, within the first year of diagnosis or post-relapse.
FINDINGS AL creates a state of imbalance, which may initiate a search for new equilibrium. Patients' journeys toward making sense of their illness may involve three interchangeable processes. CONCLUSIONS Findings of this contextually and methodologically novel study highlight the complex nature of sense-making for patients experiencing AL.
INTERPRETATION Nurses can take valuable lessons on how to manage the invisibility of AL, enhance trust in healthcare professionals, address the impact of isolation, and facilitate the making-sense processes of patients in ways that favor their short- and long-term psychosocial adjustment.
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36
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Patient-reported quality of life after allogeneic hematopoietic cell transplantation or chemotherapy for acute leukemia. Bone Marrow Transplant 2015; 50:1241-9. [PMID: 26076127 DOI: 10.1038/bmt.2015.137] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/21/2015] [Accepted: 04/29/2015] [Indexed: 01/13/2023]
Abstract
When discussing treatment options for patients with acute leukemia, it is important to acknowledge the impact of allogeneic hematopoietic cell transplantation (allo-HCT) or chemotherapy on quality of life (QOL). We performed a cross-sectional questionnaire study that administered SF-36, FACT-Leukemia and EuroQOL5D to 524 acute leukemia survivors, to compare patient-reported QOL between chemotherapy and allo-HCT, and to elucidate predictors of QOL. Patients who received chemotherapy alone had a better physical QOL than those who received allo-HCT. On the other hand, the allo-HCT group reported a better mental QOL. In the comparison of QOL in the allo-HCT patients according to the presence of GVHD at survey, patients who had GVHD symptoms experienced statistically and clinically significantly worse QOL than those who did not. In the allo-HCT patients without GVHD, the physical QOL was comparable to that in the chemotherapy patients, and they experienced significantly better mental and general QOL than the chemotherapy patients. GVHD and immunosuppressive drugs at survey were strongly associated with worse QOL after allo-HCT. In the chemotherapy group, a shorter time between treatment completion and survey was significantly associated with worse QOL. Further evaluation of QOL by a longitudinal assessment with quantitative and qualitative analyses are warranted.
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Feeling powerless: Locus of control as a potential target for supportive care interventions to increase quality of life and decrease anxiety in ovarian cancer patients. Gynecol Oncol 2015; 138:388-93. [PMID: 25988961 DOI: 10.1016/j.ygyno.2015.05.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/07/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE To evaluate if an individual's locus of control (LOC) predicts various quality of life (QOL) and mental well-being measures. To identify targets that might enhance the overall spiritual well-being and QOL of ovarian cancer patients. METHODS Multi-site analysis of women with newly diagnosed stages II-IV ovarian, primary peritoneal or fallopian tube cancer. Patients completed the following surveys: Locus of Control Scale (LOC), Functional Assessment of Chronic Illness Therapy-Ovarian (FACT-O), Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp), Edmonton Symptom Assessment score (ESAS), Hospital Anxiety Depression Scale (HADS), Templer's Death Anxiety Scale (DAS), and Herth Hope Index (HHI). Regression models were created to examine the effect of LOC upon QOL, symptoms, and other measures of mental well-being. These models adjusted for the effect of site of care, race, and partnership status as potential confounders. RESULTS This study enrolled 104 patients from three separate treatment facilities. After adjusting for site, race and partnership status, higher levels of external LOC predicted decreased QOL (FACT-O) (p<0.05). Higher levels of external LOC also correlated with increased death anxiety and general anxiety (p≤0.05). Additionally, higher levels of external LOC predicted decreased hope (HHI) (p≤0.01). DISCUSSION Ovarian cancer patients with a high external LOC may be at risk for decreased QOL at the time of their cancer diagnosis. They may also experience higher levels of anxiety and decreased feelings of hope. Identification of these women and interventions designed to increase a woman's sense of control over her situation may improve QOL and overall mental well-being.
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Amler S, Sauerland MC, Deiters C, Büchner T, Schumacher A. Factors influencing life satisfaction in acute myeloid leukemia survivors following allogeneic stem cell transplantation: a cross-sectional study. Health Qual Life Outcomes 2015; 13:28. [PMID: 25888906 PMCID: PMC4349480 DOI: 10.1186/s12955-015-0222-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 02/06/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Allogeneic stem cell transplantation (alloSCT) is the preferred option of postremission therapy for high-risk patients suffering from acute myeloid leukemia (AML). Therefore, monitoring life satisfaction (LS) of long-term survivors following alloSCT is becoming increasingly important for oncologists. The aim of the study was to evaluate individual survivor priority of various general and health-related domains of life and their satisfaction with these domains. Furthermore, we investigated the impact of general and health-related LS on resilience, anxiety, depression and quality of life in AML survivors following alloSCT. METHODS Forty-one AML survivors (median age at time of assessment = 49.0 years) who had undergone alloSCT (median time since transplantation = 3.1 years) were enrolled in the study. Psychosocial parameters were assessed using the following instruments: FLZ(M) (Questions on Life Satisfaction), EORTC QLQ-C30, HADS (Hospital Anxiety and Depression Scale) and the RS-25 (Resilience Scale-25 items). Correlation analyses were computed to reveal the associations between the different questionnaires. RESULTS Independence from help or care, well-regulated living conditions and financial security contributed positively to LS, whereas being off work due to health-reasons and dissatisfaction with physical aspects were negatively associated to the subjective feelings of overall satisfaction. Moreover, a high quality of life was strongly positively correlated with LS (Spearman's rho general LS: 0.643 and health-related LS: 0.726, both p < 0.001). A high degree of resilience was also strongly positively correlated with better LS (general LS: 0.700, health-related LS: 0.675, both p < 0.001). Symptoms of anxiety and depression were associated with an impaired general LS (anxiety: -0.674, depression: -0.698, both p < 0.001). CONCLUSIONS Our results indicate that LS should be considered an important key contributor to the survivors' well-being following alloSCT. Thus, identifying protective psychological and physical factors that relieve stressors is of high importance in order to support long-term AML survivors with their special needs.
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Affiliation(s)
- Susanne Amler
- Institute of Biostatistics and Clinical Research, University of Muenster, Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany.
| | - Maria Cristina Sauerland
- Institute of Biostatistics and Clinical Research, University of Muenster, Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany.
| | - Christian Deiters
- University Hospital of Muenster, Medicine A - Hematology, Oncology, Hemostaseology and Pneumology, Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany.
| | - Thomas Büchner
- University Hospital of Muenster, Medicine A - Hematology, Oncology, Hemostaseology and Pneumology, Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany.
| | - Andrea Schumacher
- University Hospital of Muenster, Medicine A - Hematology, Oncology, Hemostaseology and Pneumology, Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany.
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Bergenthal N, Will A, Streckmann F, Wolkewitz KD, Monsef I, Engert A, Elter T, Skoetz N. Aerobic physical exercise for adult patients with haematological malignancies. Cochrane Database Syst Rev 2014:CD009075. [PMID: 25386666 DOI: 10.1002/14651858.cd009075.pub2] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although people with haematological malignancies have to endure long phases of therapy and immobility which is known to diminish their physical performance level, the advice to rest and avoid intensive exercises is still common practice. This recommendation is partly due to the severe anaemia and thrombocytopenia from which many patients suffer. The inability to perform activities of daily living restricts them, diminishes their quality of life and can influence medical therapy. OBJECTIVES To evaluate the efficacy, safety and feasibility of aerobic physical exercise for adults suffering from haematological malignancies. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2014, Issue 1) and MEDLINE (1950 to January 2014) as well as conference proceedings for randomised controlled trials (RCTs). SELECTION CRITERIA We included RCTs comparing an aerobic physical exercise intervention, intending to improve the oxygen system, in addition to standard care with standard care only for adults suffering from haematological malignancies. We also included studies that evaluated aerobic exercise in addition to strength training. We excluded studies that investigated the effect of training programmes that were composed of yoga, tai chi chuan, qigong or similar types of exercise. We also excluded studies exploring the influence of strength training without additive aerobic exercise. Additionally, we excluded studies assessing outcomes without any clinical impact. DATA COLLECTION AND ANALYSIS Two review authors independently screened search results, extracted data and assessed the quality of trials. We used risk ratios (RRs) for adverse events and 100-day survival, standardised mean differences for quality of life (QoL), fatigue, and physical performance, and mean differences for anthropometric measurements. MAIN RESULTS Our search strategies identified 1518 potentially relevant references. Of these, we included nine RCTs involving 818 participants. The potential risk of bias in these trials is unclear, due to poor reporting.The majority of participants suffered from acute lymphoblastic leukaemia (ALL), acute myeloid leukaemia (AML), malignant lymphoma and multiple myeloma, and six trials randomised people receiving stem cell transplantation. Mostly, the exercise intervention consisted of various walking intervention programmes with different duration and intensity levels.Our primary endpoint of overall survival (OS) was not analysed in any of the included trials, but three trials reported deceased participants during the course of the study or during the first 100 days. There is no evidence for a difference between participants exercising and those in the control group (RR 0.93; 95% CI 0.59 to 1.47; P = 0.75; 3 trials, 269 participants, moderate quality of evidence).Four trials analysed the influence of exercise intervention on quality of life (QoL). Excluding one trial with serious baseline imbalances, physical exercise improves QoL (SMD 0.26; 95% CI 0.03 to 0.49; P = 0.03; 3 trials, 291 participants, low quality of evidence). This positive effect of exercise was also found in the subscales physical functioning (SMD 0.33; 95% CI 0.13 to 0.52; P = 0.0009; 4 trials, 422 participants, moderate quality of evidence) and depression (SMD 0.25; 95% CI -0.00 to 0.50; P = 0.05; 3 trials, 249 participants, low quality of evidence). However, there is no evidence for a difference between additional exercise and standard treatment for the subscale anxiety (SMD -0.18; 95% CI -0.64 to 0.28; P = 0.45; 3 trials, 249 participants, low quality of evidence). Seven trials (692 participants) evaluated fatigue. There is moderate quality of evidence that exercise improves fatigue (SMD 0.24; 95% CI 0.08 to 0.40; P = 0.003).Eight studies evaluated various aspects of physical performance (e.g. aerobic capacity, cardiovascular fitness), but none of them could be pooled in a meta-analysis. In seven trials there is a tendency or statistically significant effect favouring the exercise group (very low quality of evidence).Three trials (266 participants) investigated serious adverse events (SAEs) (e.g. bleeding, fever, pneumonia, deep vein thrombosis, and infection), and one trial (122 participants) assessed adverse events (AEs). There is no evidence for a difference between arms in terms of SAEs (RR 1.44; 95% CI 0.96 to 2.18; P = 0.06) or AEs (RR 7.23; 95% CI 0.38 to 137.05; P = 0.19); both findings are based on low quality of evidence. AUTHORS' CONCLUSIONS There is no evidence for differences in mortality between the exercise and control groups. Physical exercise added to standard care can improve quality of life, especially physical functioning, depression and fatigue. Currently, there is inconclusive evidence regarding anxiety, physical performance, serious adverse events and adverse events.We need further trials with more participants and longer follow-up periods to evaluate the effects of exercise intervention for people suffering from haematological malignancies. Furthermore, we need trials with overall survival as the primary outcome to determine whether the suggested benefits will translate into a survival advantage. To enhance comparability of study data, development and implementation of core sets of measuring devices would be helpful.
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Affiliation(s)
- Nils Bergenthal
- Cochrane Haematological Malignancies Group, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany, 50924
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Pillay B, Lee SJ, Katona L, De Bono S, Burney S, Avery S. A prospective study of the relationship between sense of coherence, depression, anxiety, and quality of life of haematopoietic stem cell transplant patients over time. Psychooncology 2014; 24:220-7. [PMID: 25052297 DOI: 10.1002/pon.3633] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/30/2014] [Accepted: 07/07/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The primary aim of this study was to examine the impact of patient sense of coherence (SOC) on anxiety and depressive symptoms, and quality of life (QoL) dimensions in the acute phase of haematopoietic stem cell transplantation (HSCT). A secondary aim was to determine if SOC measured pre-transplant was predictive of psychological distress and QoL post-transplantation, after controlling for physical wellbeing. METHOD A series of measures was completed by 60 HSCT patients prior to transplantation. Follow-up data were collected at 2-3 weeks and 3 months post-transplantation. Measures administered included the Brief Symptom Inventory-18, Orientation to Life Questionnaire, and Functional Assessment of Cancer Therapy-Bone Marrow Transplantation. RESULTS When compared across the three time points, depression levels, and physical and functional wellbeing were worst at 2-3 weeks post-transplantation. SOC was positively associated with physical wellbeing prior to HSCT but not after transplantation. Weaker SOC predicted higher levels of depression, and poorer social, emotional, and functional wellbeing at both follow-up points, after accounting for physical wellbeing. CONCLUSIONS Given that SOC was related to depression and QoL dimensions post-transplantation, it may be important for health care professionals to conduct psychosocial assessments to determine patient SOC. This would enable provision of tailored psychological support prior to and following stem cell transplantation.
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Affiliation(s)
- Brindha Pillay
- School of Psychological Sciences, Monash University, Victoria, Australia
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Çuhadar D, Tanriverdi D, Pehlivan M, Kurnaz G, Alkan S. Determination of the psychiatric symptoms and psychological resilience levels of hematopoietic stem cell transplant patients and their relatives. Eur J Cancer Care (Engl) 2014; 25:112-21. [PMID: 25040559 DOI: 10.1111/ecc.12219] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2014] [Indexed: 12/22/2022]
Abstract
This study was performed to evaluate psychiatric symptoms and resilience levels of the hematopoietic stem cell transplant patients and their relatives. The study enrolled 51 patients and 45 relatives undergoing bone marrow transplantation. Data were collected using Personal Information Form, Brief Symptom Inventory and Resilience Scale for Adults. Psychiatric symptoms of both patients and their relatives were negatively associated with resilience levels. Patients and their relatives with a higher degree of resilience showed a lower degree of psychiatric symptoms. The study results demonstrate that haematopoietic stem cell transplantation is a process that affects patients as well as their families. We suggest that patients and their family members be evaluated for psychiatric symptoms by nurses during this process and resilience level of patients be increased by helping them improve their coping and problem-solving skills for adaptation throughout the process.
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Affiliation(s)
- D Çuhadar
- Department of Psychiatric Nursing, Health Science Faculty, Gaziantep University, Gaziantep, Turkey
| | - D Tanriverdi
- Department of Psychiatric Nursing, Health Science Faculty, Gaziantep University, Gaziantep, Turkey
| | - M Pehlivan
- Department of Internal Medicine, Hematology, Gaziantep University Medical School, Gaziantep, Turkey
| | - G Kurnaz
- Bone Marrow Transplantation Unit, Gaziantep University, Medical School Hospital, Gaziantep, Turkey
| | - S Alkan
- Bone Marrow Transplantation Unit, Gaziantep University, Medical School Hospital, Gaziantep, Turkey
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Barban A, Coracin FL, Musqueira PT, Barban A, Ruiz LP, Ruiz MA, Saboya R, Dulley FL. Analysis of the feasibility of early hospital discharge after autologous hematopoietic stem cell transplantation and the implications to nursing care. Rev Bras Hematol Hemoter 2014; 36:264-8. [PMID: 25031165 PMCID: PMC4207907 DOI: 10.1016/j.bjhh.2014.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 03/18/2014] [Indexed: 11/19/2022] Open
Abstract
Introduction Autologous hematopoietic stem cell transplantation is a conduct used to treat some hematologic diseases and to consolidate the treatment of others. In the field of nursing, the few published scientific studies on nursing care and early hospital discharge of transplant patients are deficient. Knowledge about the diseases treated using hematopoietic stem cell transplantation, providing guidance to patients and caregivers and patient monitoring are important nursing activities in this process. Guidance may contribute to long-term goals through patients’ short-term needs. Aim To analyze the results of early hospital discharge on the treatment of patients submitted to autologous transplantation and the influence of nursing care on this conduct. Methods A retrospective, quantitative, descriptive and transversal study was conducted. The hospital records of 112 consecutive patients submitted to autologous transplantation in the period from January to December 2009 were revisited. Of these, 12 patients, who remained in hospital for more than ten days after transplantation, were excluded from the study. Results The medical records of 100 patients with a median age of 48.5 years (19–69 years) were analyzed. All patients were mobilized and hematopoietic stem cells were collected by leukapheresis. The most common conditioning regimes were BU12Mel100 and BEAM 400. Toxicity during conditioning was easily managed in the outpatient clinic. Gastrointestinal toxicity, mostly Grades I and II, was seen in 69% of the patients, 62% of patients had diarrhea, 61% of the patients had nausea and vomiting and 58% had Grade I and II mucositis. Ten patients required hospitalization due to the conditioning regimen. Febrile neutropenia was seen in 58% of patients. Two patients died before Day +60 due to infections, one with aplasia. The median times to granulocyte and platelet engraftment were 12 days and 15 days, respectively, with median red blood cell and platelet transfusions until discharge of three and four units, respectively. Twenty-three patients required rehospitalization before being discharged from the outpatient clinic. Conclusion The median time to granulocyte engraftment was 12 days and during the aplasia phase few patients were hospitalized or suffered infections. The toxicity of the conditioning was the leading cause of rehospitalization. The nursing staff participated by providing guidance to patients and during the mobilization, transplant and outpatient follow-up phases, thus helping to successfully manage toxicity.
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Affiliation(s)
| | - Fabio Luiz Coracin
- Universidade de São Paulo (USP), São Paulo, SP, Brazil; Universidade Nove de Julho (Uninove), São Paulo, SP, Brazil
| | | | | | - Lilian Piron Ruiz
- Associação Portuguesa de Beneficência, São José do Rio Preto, SP, Brazil
| | - Milton Artur Ruiz
- Universidade do Estado de São Paulo (UNESP), São José do Rio Preto, SP, Brazil
| | | | - Frederico Luiz Dulley
- Universidade de São Paulo (USP), São Paulo, SP, Brazil; Hospital Inglês, São Paulo, SP, Brazil.
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Assessing the Outcomes of a Supervised Exercise Intervention Following Recent Allogeneic Bone Marrow Transplantation: A Case Report. REHABILITATION ONCOLOGY 2014. [DOI: 10.1097/01893697-201432020-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pillay B, Lee SJ, Katona L, Burney S, Avery S. Psychosocial factors associated with quality of life in allogeneic stem cell transplant patients prior to transplant. Psychooncology 2013; 23:642-9. [PMID: 24375571 DOI: 10.1002/pon.3462] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 11/19/2013] [Accepted: 11/22/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The primary aim of this retrospective study was to determine levels of psychological distress and quality of life (QoL) immediately prior to allogeneic stem cell transplantation. The secondary aim was to examine the demographic, medical and psychosocial factors that were correlated with various QoL domains at this stage of treatment. METHODS A series of measures was completed by 122 allograft patients as part of routine psychological assessment at the treating hospital prior to undergoing the transplant. These included the Mental Adjustment to Cancer Scale, the Brief Symptom Inventory-18 and the World Health Organisation Quality of Life-BREF. Demographic and medical data were also extracted. RESULTS In this study, 12% and 14% of the sample experienced significant levels of depressive and anxiety symptoms, respectively. Half of the sample reported impaired physical QoL, whereas approximately 40% reported poor psychological and social QoL. Besides relationship status, the limited number of demographic (age and gender) and medical factors (disease status) tested did not contribute significantly to reported QoL. After controlling for medical and demographic factors, weaker Fighting Spirit and higher levels of depression (trend towards significance) were associated with poorer physical and social QoL. CONCLUSIONS The association among psychological distress, coping responses and QoL indicates that poor psychosocial functioning pre-transplant renders an increased likelihood of experiencing impaired QoL across various dimensions. It thus seems important that psychologically vulnerable patients are identified early in the treatment process. If psychosocial adjustment were improved, patients may experience better QoL pre-transplant with a potential subsequent influence on post-transplant outcomes.
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Affiliation(s)
- Brindha Pillay
- School of Psychology and Psychiatry, Monash University, Clayton, Victoria, Australia
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45
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Schumacher A, Sauerland C, Silling G, Berdel WE, Stelljes M. Resilience in patients after allogeneic stem cell transplantation. Support Care Cancer 2013; 22:487-93. [PMID: 24101151 DOI: 10.1007/s00520-013-2001-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 09/23/2013] [Indexed: 01/18/2023]
Abstract
PURPOSE After undergoing allogeneic stem cell transplantation (alloSCT), patients adapt in very different ways to their taxing situation. Some patients cope very well; others almost seem to fail. Psychosocial variables are important factors for successful reintegration. Besides quality of life, resilience may help to understand the variance in individual differences in adaptation after alloSCT. METHODS A pilot study at the University Hospital Muenster, Germany, assessed resilience in patients after alloSCT. The sample included 75 patients (leukemia, lymphoma, myeloma, aplastic anemia) aged 20-76 years. The instruments Resilience Scale RS-25, Hospital Anxiety and Depression Scale, General Self-efficacy Scale, and EORTC QLQ-C30 were used. RESULTS Resilience is positively correlated with quality of life (Spearman's rho 0.587) and social functioning (0.472), negatively with anxiety (-0.491) and depression (-0.577). Dividing the sample at the median resilience score of 144 reveals that high-resilience patients report less anxiety (p = 0.008) and depression (p < 0.001); higher physical (p = 0.041), emotional (p = 0.030), and social functioning (p = 0.003); and a better quality of life (p < 0.001) than low-resilience patients. No effects on resilience were found for age, gender, and primary disease entity. The high correlation of resilience and self-efficacy (r = 0.698) shows the strong relationship between the two concepts. Our results indicate a potential influence of the time span from alloSCT on patients' resilience. CONCLUSIONS Resilience should be considered as a protective psychosocial factor for patients after alloSCT. A high degree of resilience can help patients to adapt to their situation and to resume their everyday life.
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Affiliation(s)
- Andrea Schumacher
- Department of Medicine A/Hematology and Oncology, University of Muenster, Albert-Schweitzer-Campus 1, Bldg. A 1, 48149, Muenster, Germany,
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Healing stories: Narrative characteristics in cancer survivorship narratives and psychological health among hematopoietic stem cell transplant survivors. Palliat Support Care 2013; 12:261-7. [DOI: 10.1017/s1478951513000205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectives:Survivors of hematopoietic stem cell transplant (HSCT) have experienced a life threatening and potentially traumatic illness and treatment that make them vulnerable to long lasting negative psychological outcomes, including anxiety and depression. Nevertheless, studies show that overcoming cancer and its treatment can present an opportunity for personal growth and psychological health (reduced symptoms of anxiety and depression and high levels of emotional well-being) through resilience. However, research has not yet clarified what differentiates HSCT survivors who experience psychological growth from those who do not. By analyzing recovery narratives, we examined whether HSCT survivors’ interpretation of their experiences helps explain differences in their post-treatment psychological health.Methods:Guided by narrative psychology theory, we analyzed the narratives of 23 HSCT survivors writing about their experience of cancer treatment. Psychological health was measured by: (1) emotional well-being subscale part of the Functional Assessment of Cancer Therapy Bone Marrow Transplant (FACT-BMT), (2) depression, and (3) anxiety subscales of the Brief Symptom Inventory.Results:Findings revealed a positive relation between psychological health and a greater number of redemption episodes (going from an emotionally negative life event to an emotionally positive one) as well as fewer negative emotional expressions.Significance of the results:Theoretical and practical implications of these findings are discussed, showing how narratives can inform interventions to assist cancer survivors with their psychological recovery.
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McGregor BA, Syrjala KL, Dolan ED, Langer SL, Redman M. The effect of pre-transplant distress on immune reconstitution among adult autologous hematopoietic cell transplantation patients. Brain Behav Immun 2013; 30 Suppl:S142-8. [PMID: 22910186 PMCID: PMC3549315 DOI: 10.1016/j.bbi.2012.07.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 07/06/2012] [Accepted: 07/23/2012] [Indexed: 01/25/2023] Open
Abstract
Myeloablative hematopoietic cell transplantation (HCT) is a common treatment for hematological malignancy. Delayed immune reconstitution following HCT is a major impediment to recovery with patients being most vulnerable during the first month after transplant. HCT is a highly stressful process. Because psychological distress has been associated with down regulation of immune function we examined the effect of pre-transplant distress on white blood cell (WBC) count among 70 adult autologous HCT patients during the first 3 weeks after transplant. The participants were on average 38 years old; 93% Caucasian, non-Hispanic and 55% male. Pre-transplant distress was measured 2-14 days before admission using the Cancer and Treatment Distress (CTXD) scale, and the Symptom Checklist-90-R (SCL-90-R) anxiety and depression subscales. WBC count was measured during initial immune recovery on days 5 through 22 post-transplant. Linear mixed model regression analyses controlling for gender and treatment-related variables revealed a significant effect of the mean pre-transplant SCL Anxiety-Depression score on WBC recovery. We found no significant effect of pre-transplant CTXD on WBC recovery. In general, higher levels of pre-treatment anxiety and depression were associated with slower WBC recovery. Psychological modulation of WBC recovery during HCT suggests a unique mechanism by which psychological distress can exert influence over the immune system. Given that WBC recovery is essential to survival for HCT patients, these data provide a rationale for treating anxiety and depression in HCT patients.
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Affiliation(s)
- Bonnie A McGregor
- Public Health Sciences, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, WA 98109, USA.
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Norkin M, Hsu JW, Wingard JR. Quality of life, social challenges, and psychosocial support for long-term survivors after allogeneic hematopoietic stem-cell transplantation. Semin Hematol 2012; 49:104-9. [PMID: 22221790 DOI: 10.1053/j.seminhematol.2011.10.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Over the last two decades quality of life (QoL) and the social challenges of allogeneic hematopoietic stem cell transplant (allo-HSCT) survivors have been emerging as subjects of extensive research and are now considered as very important aspects in the pretransplant evaluation and management of allo-HSCT recipients. Recognition of QoL challenges in allo-HSCT survivors allows timely interventions leading to improvement of post-transplant outcomes. It needs to be recognized that long-lasting life changes associated with survivorship after allo-HSCT also significantly affect QoL of partners of allo-HSCT survivors. Currently, resources should be focused on how research findings can be used by patients, their partners, and physicians to optimize QoL and psychosocial adjustment.
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Affiliation(s)
- Maxim Norkin
- University of Florida College of Medicine, Gainesville, FL 32610-0278, USA.
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Garssen B, Boomsma MF, de Jager Meezenbroek E, Porsild T, Berkhof J, Berbee M, Visser A, Meijer S, Beelen RHJ. Stress management training for breast cancer surgery patients. Psychooncology 2012; 22:572-80. [DOI: 10.1002/pon.3034] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 12/10/2011] [Accepted: 12/21/2011] [Indexed: 11/10/2022]
Affiliation(s)
- Bert Garssen
- Centre for Psycho-Oncology; Helen Dowling Institute; Utrecht The Netherlands
| | - Martijn F. Boomsma
- Centre for Psycho-Oncology; Helen Dowling Institute; Utrecht The Netherlands
| | | | - Terry Porsild
- Department of Surgery; Medical Centre Alkmaar; Alkmaar The Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics; VU University Medical Centre; Amsterdam The Netherlands
| | - Monique Berbee
- Department of Surgery; Medical Centre Alkmaar; Alkmaar The Netherlands
| | - Adriaan Visser
- Centre for Psycho-Oncology; Helen Dowling Institute; Utrecht The Netherlands
| | - Sybren Meijer
- Department of Surgical Oncology; VU University Medical Centre; Amsterdam The Netherlands
| | - Rob H. J. Beelen
- Department of Cell Biology and Immunology; VU University Medical Centre; Amsterdam The Netherlands
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50
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Allart P, Soubeyran P, Cousson-Gélie F. Are psychosocial factors associated with quality of life in patients with haematological cancer? A critical review of the literature. Psychooncology 2012; 22:241-9. [PMID: 22287503 DOI: 10.1002/pon.3026] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 12/08/2011] [Accepted: 12/08/2011] [Indexed: 11/12/2022]
Abstract
BACKGROUND Haematological cancers differ from other cancers mainly with regard to treatment strategies: surgery is used for diagnostic purposes but rarely for treatment, whereas chemotherapy is of central importance and, in some cases, cures patients. This article reviews studies that examine the relationships between psychosocial factors and quality of life (QoL) in haematological cancer patients. METHODS A review of the literature was conducted from the databases 'PsycInfo', 'Medline' and 'Science Direct' using the keywords 'lymphoma', 'leukaemia', 'myeloma', 'quality of life', 'psychosocial factors', 'coping', 'social support', 'personality', 'anxiety,' 'depression', 'locus of control' and 'alexithymia'. RESULTS Fourteen studies were analysed. One study found positive relationships between sense of coherence and health-related QoL, whereas another showed a positive link between self-esteem and QoL. Another study suggested that a high external health locus of control was related to a better QoL. Fighting spirit had a positive impact on QoL for two studies, and helplessness-hopelessness was positively related to emotional distress in one study. Two studies indicated the relationships between emotional distress and QoL. Satisfaction with information about disease determined emotional distress in another study. Social support, general health perceptions, global meaning or spirituality were found to improve QoL in four other reports. CONCLUSION Literature about the relationships between psychosocial factors and QoL is lacking. Sense of coherence, self-esteem and health locus of control, coping strategies, social support, global meaning or emotional distress are associated with QoL. Results concerning coping and social support should be interpreted with caution because of level II evidence in studies.
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Affiliation(s)
- Priscilla Allart
- Laboratory of Psychology Health and Quality of Life, University Bordeaux Segalen, Bordeaux, France.
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