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. 2023 Apr 7;12(8):2756.
doi: 10.3390/jcm12082756.

Fatigue as Mediator Factor in PTSD-Symptoms after Allogeneic Hematopoietic Stem Cell Transplantation

Giulia Di Francesco  1 , Filippo Cieri  2 , Roberto Esposito  3   4 , Pierpaola Sciarra  1 , Valeria Ballarini  1 , Mauro Di Ianni  1 , Stella Santarone  5
Affiliations

Fatigue as Mediator Factor in PTSD-Symptoms after Allogeneic Hematopoietic Stem Cell Transplantation

Giulia Di Francesco et al. J Clin Med. .

Abstract

Background: 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.

Methods: 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).

Results: 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 (p < 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 *).

Conclusions: 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.

Keywords: allogeneic haemopoietic stem cell transplantation; fatigue; hematological malignancies; post-traumatic stress disorder; quality of life.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The mediation of PTSD symptoms. Note: Fact PWB: domains of well-being: physical; FWB: domains of well-being functional; SWB: domains of well-being social; EWB: domains of well-being emotional; AC: additional concerns; PTSD: Post Traumatic Stress Disorder; QoL: Quality of life; Path values are the path coefficients (standard errors). ** p < 0.01.
See this image and copyright information in PMC

References

    1. Esser P., Kuba K., Mehnert A., Schwinn A., Schirmer L., Schulz-Kindermann F., Kruse M., Koch U., Zander A.R., Kroger N., et al. Investigating the temporal course, relevance and risk factors of fatigue over 5 years: A prospective study among patients receiving allogeneic HSCT. Bone Marrow Transplant. 2017;52:753–758. doi: 10.1038/bmt.2016.344. - DOI - PubMed
    1. Cooke L., Gemmill R., Kravits K., Grant M. Psychological issues of stem cell transplant. Semin. Oncol. Nurs. 2009;25:139–150. doi: 10.1016/j.soncn.2009.03.008. - DOI - PMC - PubMed
    1. Fenech A.L., Van Benschoten O., Jagielo A.D., Ufere N.N., Topping C.E.W., Clay M., Jones B.T., Traeger L., Temel J.S., El-Jawahri A. Post-Traumatic Stress Symptoms in Hematopoietic Stem Cell Transplant Recipients. Transplant. Cell Ther. 2021;27:341.e1–341.e6. doi: 10.1016/j.jtct.2021.01.011. - DOI - PMC - PubMed
    1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Publishing; Arlington, VA, USA: 2013.
    1. Kuba K., Esser P., Scherwath A., Schirmer L., Schulz-Kindermann F., Dinkel A., Balck F., Koch U., Kröger N., Götze H., et al. Cancer-and-treatment-specific distress and its impact on posttraumatic stress in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) Psycho. Oncol. 2017;26:1164–1171. doi: 10.1002/pon.4295. - DOI - PubMed

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