El-Jawahri Areej R, Traeger Lara N, Kuzmuk Kailyn, Eusebio Justin R, Vandusen Harry B, Shin Jennifer A, Keenan Tanya, Gallagher Emily R, Greer Joseph A, Pirl William F, Jackson Vicki A, Ballen Karen K, Spitzer Thomas R, Graubert Timothy A, McAfee Steven L, Dey Bimalangshu R, Chen Yi-Bin A, Temel Jennifer S
Department of Hematology Oncology, Massachusetts General Hospital, Boston, MA.
Cancer. 2015 Mar 15;121(6):951-9. doi: 10.1002/cncr.29149. Epub 2014 Dec 2.
We conducted a study to investigate the impact of hospitalization for hematopoietic stem cell transplantation (HCT) on the quality of life (QOL) and mood of patients and family caregivers (FC).
We conducted a longitudinal study of patients who were hospitalized for HCT and their FC. We assessed QOL (using the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation) and mood (using the Hospital Anxiety and Depression Scale) at baseline (6 days before HCT), day +1, and day +8 of HCT. We administered the Medical Outcomes Study Health Survey Short Form-36 to examine FC QOL (Physical Component Scale and Mental Component Scale). To identify predictors of changes in QOL, we used multivariable linear mixed models.
We enrolled 97% of eligible patients undergoing autologous (30 patients), myeloablative (30 patients), or reduced intensity (30 patients) allogeneic HCT. Patients' QOL markedly declined (mean Functional Assessment of Cancer Therapy-Bone Marrow Transplantation score, 109.6 to 96.0; P<.0001) throughout hospitalization. The percentage of patients with depression (Hospital Anxiety and Depression Scale-Depression score of >7) more than doubled from baseline to day +8 (15.6% to 37.8%; P<.0001), whereas the percentage of patients with anxiety remained stable (22.2%; P = .8). These results remained consistent when data were stratified by HCT type. Baseline depression (β, -2.24; F, 42.2 [P<.0001]) and anxiety (β, -0.63; F, 4.4 [P =.03]) were found to independently predict worse QOL throughout hospitalization. FC QOL declined during the patient's hospitalization (physical component scale: 83.1 to 79.6 [P =.03] and mental component scale: 71.6 to 67.4 [P =.04]).
Patients undergoing HCT reported a steep deterioration in QOL and substantially worsening depression during hospitalization. Baseline anxiety and depression predicted worse QOL during hospitalization, underscoring the importance of assessing pre-HCT psychiatric morbidity.
我们开展了一项研究，以调查造血干细胞移植（HCT）住院治疗对患者及家庭照料者（FC）生活质量（QOL）和情绪的影响。
我们对因HCT住院的患者及其FC进行了一项纵向研究。我们在基线期（HCT前6天）、HCT第+1天和第+8天评估了QOL（使用癌症治疗功能评估-骨髓移植量表）和情绪（使用医院焦虑抑郁量表）。我们使用医学结局研究简明健康调查问卷-36来评估FC的QOL（生理成分量表和心理成分量表）。为了确定QOL变化的预测因素，我们使用了多变量线性混合模型。
我们纳入了97%符合条件的接受自体（30例患者）、清髓性（30例患者）或减低强度（30例患者）异基因HCT的患者。患者的QOL在整个住院期间显著下降（癌症治疗功能评估-骨髓移植量表平均得分从109.6降至96.0；P<0.0001）。抑郁患者（医院焦虑抑郁量表-抑郁得分>7）的比例从基线期到第+8天增加了一倍多（从15.6%增至37.8%；P<0.0001），而焦虑患者的比例保持稳定（22.2%；P = 0.8）。当按HCT类型对数据进行分层时，这些结果保持一致。发现基线期抑郁（β，-2.24；F，42.2 [P<0.0001]）和焦虑（β，-0.63；F，4.4 [P = 0.03]）可独立预测整个住院期间较差的QOL。患者住院期间FC的QOL下降（生理成分量表：从83.1降至79.6 [P = 0.03]，心理成分量表：从71.6降至67.4 [P = 0.04]）。
接受HCT的患者报告其QOL在住院期间急剧恶化，抑郁情况明显加重。基线期焦虑和抑郁可预测住院期间较差的QOL，这突出了评估HCT前精神疾病发病率的重要性。
