Di Francesco Giulia, Cieri Filippo, Esposito Roberto, Sciarra Pierpaola, Ballarini Valeria, Di Ianni Mauro, Santarone Stella
Hematology Unit, Department of Oncology-Hematology, Pescara Hospital, 65100 Pescara, Italy.
Department of Neurology, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV 89106, USA.
J Clin Med. 2023 Apr 7;12(8):2756. doi: 10.3390/jcm12082756.
Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) is a valid treatment for hematological oncological or metabolic diseases. Despite its therapeutic efficacy, it is an aggressive treatment that impacts negatively on quality of life (QoL) and may result in Post-Traumatic Stress Disorder (PTSD) symptoms. The aim of this study is to explore rates and risk factors for PTSD symptoms, and fatigue in post-HSCT patients with hematological malignancies.
A total of 123 patients after HSCT were evaluated for PTSD symptoms, QoL and fatigue. PTSD symptoms were assessed with the Impact of Event Scale- Revised (IES-R), QoL was measured with Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) and fatigue symptoms were assessed with Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F).
A total of 58.54% of the sample developed PTSD symptoms after transplant. Patients with PTSD symptoms reported significantly lower QoL total scores and significantly higher fatigue than those without PTSD symptoms ( < 0.001). The SEM analysis showed that worse QoL and fatigue affected PTSD symptomatology along different pathways. Fatigue was found as a major influencing factor of PTSD symptoms directly (β = 0.31 **), while QoL only through the mediation of fatigue at a lesser extent. (β = 0.33 *).
Our findings indicate that QoL is a concurrent causative factor to the development of PTSD symptomatology through the mediating role of fatigue. Innovative interventions before transplantation to prevent PTSD symptoms should be investigated to improve survival and QoL in patients.
异基因造血干细胞移植（HSCT）是治疗血液肿瘤或代谢性疾病的有效方法。尽管具有治疗效果，但它是一种激进的治疗方式，会对生活质量（QoL）产生负面影响，并可能导致创伤后应激障碍（PTSD）症状。本研究的目的是探讨血液系统恶性肿瘤HSCT后患者PTSD症状和疲劳的发生率及危险因素。
对123例HSCT后的患者进行PTSD症状、生活质量和疲劳评估。采用事件影响量表修订版（IES-R）评估PTSD症状，采用癌症治疗功能评估-骨髓移植（FACT-BMT）测量生活质量，采用慢性病治疗功能评估-疲劳（FACIT-F）评估疲劳症状。
共有58.54%的样本在移植后出现PTSD症状。有PTSD症状的患者报告的生活质量总分显著低于无PTSD症状的患者，疲劳程度显著高于无PTSD症状的患者（<0.001）。结构方程模型分析表明，较差的生活质量和疲劳通过不同途径影响PTSD症状。疲劳被发现是PTSD症状的主要直接影响因素（β = 0.31 **），而生活质量仅通过疲劳的中介作用在较小程度上影响（β = 0.33 *）。
我们的研究结果表明，生活质量通过疲劳的中介作用是PTSD症状发生的并发致病因素。应研究移植前预防PTSD症状的创新干预措施，以提高患者的生存率和生活质量。
