Predictors of posttraumatic growth among hematopoietic cell transplant recipients

Abstract

Objective: Prior research has shown that cancer survivors often report positive psychological changes from the experience of cancer, or posttraumatic growth (PTG). However, few studies have focused on PTG in cancer patients recovering from hematopoietic cell transplantation (HCT). The present study measured PTG at specific milestones during the year following HCT and investigated psychosocial and treatment-related factors that may hinder or facilitate PTG.

Methods: Participants (N = 430) completed assessments of PTG, social support, and coping pre-transplant. Posttraumatic growth was also assessed at 1, 3, 6, and 12 months post-transplant. Information about treatment regimen and post-transplant complications was abstracted from medical records. Mixed-effects linear regression models were used to evaluate the extent to which pre-transplant social support, coping approaches, treatment intensity, and post-transplant complications predicted PTG.

Results: Compared to pre-transplant, PTG scores were significantly higher at 6- and 12-month post-transplant. Greater pre-transplant social support significantly predicted greater PTG across the assessment points. Use of emotional engagement coping strategies also strongly predicted post-transplant PTG. Conversely, coping styles characterized by emotional avoidance generally were not predictive of PTG. No treatment-related factors or post-transplant complications were predictive of PTG.

Conclusions: Findings indicate that supportive social relationships and coping by engaging with difficult emotions may facilitate PTG following HCT. Moreover, these factors were more important than medical characteristics in explaining PTG. Findings may guide the development of interventions to enhance positive psychological outcomes after HCT.

Keywords: cancer; coping; hematology; hematopoietic cell transplant; oncology; posttraumatic growth; psycho-oncology; social support.

Figure 1. Acceptance as a Moderator of Post-Transplant Changes in PTG

Note. Changes over time in mean PTG scores for participants in upper, upper-middle, lower-middle, and lower quartiles on acceptance. A significant interaction between acceptance and time was found, in which participants in the lowest quartile on acceptance showed markedly lower PTGI scores at the pre-transplant and 12-months post-transplant assessment points to participants reporting moderate or high acceptance.