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. 2018 Jan;27(1):125-135.
doi: 10.1007/s11136-017-1705-3. Epub 2017 Sep 12.

Everyday life following hematopoietic stem cell transplantation: decline in physical symptoms within the first month and change-related predictors

Aleksandra Kroemeke  1 , Małgorzata Sobczyk-Kruszelnicka  2 , Zuzanna Kwissa-Gajewska  3
Affiliations

Everyday life following hematopoietic stem cell transplantation: decline in physical symptoms within the first month and change-related predictors

Aleksandra Kroemeke et al. Qual Life Res. 2018 Jan.

Abstract

Purpose: Lower quality of life, especially in the physical domain (Physical-QOL), is common in patients after hematopoietic stem cell transplantation (HSCT). However, few studies explore changes in the Physical-QOL, i.e., physical symptoms, in everyday life of patients following HSCT. The present study addresses this gap by examining patient daily physical symptoms and their predictors in terms of demographic and clinical characteristics.

Methods: Physical symptoms were reported by 188 patients (56.9% men; aged 47.6 ± 13.4 years) for 28 consecutive days after post-HSCT hospital discharge. Multilevel modeling was used to investigate fixed and random effects for physical symptom changes over time.

Results: The results indicated that the initial level of physical symptoms (immediately after hospital discharge) systematically decreased over 28 days. Treatment toxicity (WHO scale; β = 0.09, p < .01) and baseline depressive symptoms (CES-D scale; β = 0.06, p < .01) were associated with the initial level of physical symptoms. Patients with more depressive symptoms before HSCT and with more adverse treatment effects presented with more physical symptoms immediately after hospital discharge. The type of transplant, diagnosis, and conditioning regimen differentiated the course of physical symptoms. Patients with leukemias and other myeloid neoplasms (β = 0.05, p < .01), after allogeneic HSCT (β = -0.06, p < .01), and with non-myeloablative conditioning (β = -0.09, p < .01) showed a significant lower decrease in symptoms over time. Patients with multiple myeloma presented with the most rapid improvement (β = -.03, p < .05).

Conclusions: The findings suggest a heterogeneous and rather positive response to HSCT. Treatment-related conditions occurred to be a significant predictor of the intensity of change in physical functioning after HSCT.

Keywords: Hematopoietic stem cell transplantation; Intensive longitudinal study; Multilevel modeling; Physical symptoms.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and consistent with the 1964 Helsinki declaration and its later amendments, or comparable ethical standards.

Informed consent

Informed consent was obtained from each individual participants included in the study.

Figures

Fig. 1
Fig. 1
Spaghetti plot of average (thick) and patient-specific (thin) time courses of somatic symptoms for alloHSCT (left) and autoHSCT (right) groups
Fig. 2
Fig. 2
Spaghetti plot of average (thick) and patient-specific (thin) time courses of somatic symptoms for other diseases (left) and leukemias and other myeloid neoplasms (right)
Fig. 3
Fig. 3
Spaghetti plot of average (thick) and patient-specific (thin) time courses of somatic symptoms for other diseases (left) and multiple myeloma (right)
Fig. 4
Fig. 4
Spaghetti plot of average (thick) and patient-specific (thin) time courses of somatic symptoms for non-myeloablative (NMA) + reduced intensity (RIC) (left) and myeloablative (MA) conditioning (right) groups
See this image and copyright information in PMC

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