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.
Massachusetts General Hospital Cancer Center, Boston, Massachusetts.
Biol Blood Marrow Transplant. 2020 Aug;26(8):1477-1481. doi: 10.1016/j.bbmt.2020.04.014. Epub 2020 May 11.
Anhedonia, the loss of the capacity to experience pleasure, is subjectively and biologically distinct from depressed mood. Few studies have specifically examined the association of pretransplantation anhedonia with key functional outcomes (eg, health-related quality of life [QOL]) in patients with hematologic malignancies who have undergone hematopoietic stem cell transplantation (HSCT). Among 248 HSCT recipients enrolled in 2 intervention trials, we examined the associations between pretransplantation anhedonia and both QOL and fatigue at 2 weeks and 6 months post-transplantation. Across time points, patients completed the Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Therapy-Bone Marrow Transplant, and Functional Assessment of Cancer Therapy-Fatigue subscale, which we used to measure depressive symptoms, QOL and fatigue, respectively. Pretransplantation anhedonia was assessed using the corresponding item in the Patient Health Questionnaire-9. The Functional Assessment of Cancer Therapy-Bone Marrow Transplant and the Functional Assessment of Cancer Therapy-Fatigue subscales were used to measure QOL and fatigue. Associations between pretransplantation anhedonia and outcomes were assessed using regression analyses, adjusting for age, sex, transplant type, and intervention group. Ninety-eight patients (39.5%) reported pretransplantation anhedonia, of whom 60 (61%) did not meet the criteria for elevated depressive symptoms. Pretransplantation anhedonia was negatively associated with QOL at 2 weeks (B = -17.21; 95% confidence interval [CI], -23.05 to -11.30; P < .001) and at 6 months (B = -15.10; 95% CI, -21.51 to -8.69; P< .001). Pretransplantation anhedonia was also negatively associated with fatigue (2 weeks: B = -9.35; 95% CI, -12.47 to -6.22; P< .001; 6 months: B = -5.68; 95% CI, -9.07 to -2.28; P= .001). The association between pretransplantation anhedonia and QOL and fatigue remained significant after adjusting for depression scores. Pretransplantation anhedonia is negatively and significantly associated with QOL and fatigue in HSCT recipients. These findings underscore the need to incorporate anhedonia assessment in the evaluation and management of psychological distress in these patients.
快感缺失，即体验快乐的能力丧失，在主观和生物学上有别于抑郁情绪。很少有研究专门探讨血液恶性肿瘤患者在接受造血干细胞移植 (HSCT) 前的快感缺失与关键功能结局（例如，健康相关生活质量 [QOL]）之间的关系。在 248 名参与 2 项干预试验的 HSCT 受者中，我们研究了移植前快感缺失与移植后 2 周和 6 个月时 QOL 和疲劳之间的关系。在各个时间点，患者完成了医院焦虑和抑郁量表、癌症治疗-骨髓移植功能评估和癌症治疗-疲劳功能评估量表，我们分别使用这些量表来衡量抑郁症状、QOL 和疲劳。移植前快感缺失使用患者健康问卷-9 的相应项目进行评估。癌症治疗-骨髓移植功能评估和癌症治疗-疲劳功能评估量表用于衡量 QOL 和疲劳。使用回归分析评估移植前快感缺失与结局之间的关系，并调整年龄、性别、移植类型和干预组。98 名患者（39.5%）报告移植前快感缺失，其中 60 名（61%）未达到升高的抑郁症状标准。移植前快感缺失与 2 周时的 QOL 呈负相关（B=-17.21；95%置信区间 [CI]，-23.05 至-11.30；P<.001）和 6 个月时的 QOL 呈负相关（B=-15.10；95%CI，-21.51 至-8.69；P<.001）。移植前快感缺失也与疲劳呈负相关（2 周：B=-9.35；95%CI，-12.47 至-6.22；P<.001；6 个月：B=-5.68；95%CI，-9.07 至-2.28；P=0.001）。调整抑郁评分后，移植前快感缺失与 QOL 和疲劳之间的关联仍然显著。移植前快感缺失与 HSCT 受者的 QOL 和疲劳呈负相关且具有统计学意义。这些发现强调了在评估和管理这些患者的心理困扰时需要纳入快感缺失评估。
