Adverse psychological outcomes in long-term survivors of hematopoietic cell transplantation: a report from the Bone Marrow Transplant Survivor Study (BMTSS)

Abstract

Little information exists regarding long-term psychological health of hematopoietic cell transplantation (HCT) survivors. Using resources offered by the Bone Marrow Transplant Survivor Study (BMTSS), we evaluated adverse psychological outcomes in 1065 long-term HCT survivors and a healthy comparison group composed of siblings. Psychological health status was evaluated using the Brief Symptom Inventory-18. Twenty-two percent of the HCT survivors reported adverse psychological outcomes, compared with 8% of the siblings. Exposure to prednisone was associated with psychological distress across all domains (anxiety, depression, and somatic distress). Fifteen percent of the HCT survivors reported somatic distress, representing an almost 3-fold higher risk comparing to siblings. Among survivors, in addition to low annual household income and self-reported poor health, having severe/life-threatening conditions and presence of active chronic GVHD were associated with a 2-fold increased risk for somatic distress. Seven percent of the HCT survivors expressed suicidal ideation; patients with higher scores on depression subscale were most vulnerable. This study demonstrates that somatic distress is the biggest challenge faced by survivors long after HCT. These results identify vulnerable subpopulations and provide patients, families, and healthcare providers with necessary information to plan for post-HCT needs many years after HCT.

Figure 1

Magnitude of risk of poor psychological outcomes. Survivors were compared with siblings, adjusted for sex, age at study participation (continuous), race/ethnicity (non-Hispanic white, others), marital status (married, not married), income (< $20 000/y, $20 000-$60 000/y, > $60 000/y), education (did not complete high school (HS)/HS graduate, some college or higher), insurance status (yes, no), health status (poor/fair, good/excellent), and grade of chronic health conditions (none, grade 1 or 2, grade 3 or 4).

Figure 2

Prevalence of HCT survivors with adverse psychosocial outcomes as a function of time from HCT. (A) Among all survivors by years after HCT. (B) Among autologous survivors only. (C) Among allogeneic survivors only.