Depressed Mood and Other Variables Related to Bone Marrow Transplantation Survival in Acute Leukemia (original) (raw)
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Psychological factors and survival after bone marrow transplantation in patients with leukemia
Psychiatry and Clinical Neurosciences, 2003
Psychological factors may be associated with the outcome of cancer treatment, including bone marrow transplantation (BMT). However, studies on the issue have provided controversial results. In the present study, effects of mood status on the outcome was studied through a follow-up period of 1-3 years as well as in shorter periods (3 and 8 months) post-BMT in 72 Japanese patients with leukemia. Psychological status was evaluated 2 weeks before BMT using Profile of Mood States (POMS). The most major factor abstracted from the POMS subscales (Factor 1, mainly comprising anxiety, depression, anger, fatigue and confusion) was associated with disease-free survival rate at 3 months post-BMT. However, the factor most significantly associated with the outcome was gender. Females had better outcome than males through the period of 1-3 years as well as at 8 months post-BMT. When analyzed by gender, Factor 1 was associated with poor prognosis at 3 and 8 months in males. In females, however, Factor 1 was not significantly associated with the prognosis. The present results suggest an association between mood status pre-BMT and prognosis post-BMT in a gender-specific manner.
Psychological risk factors and early complications after bone marrow transplantation in adults
Bone Marrow Transplantation, 1999
Complications of bone marrow transplantation can compromise its effectiveness, and often it is not possible to predict who is at greatest risk. In a previous study we reported that certain psychological factors correlated with a high incidence of post-transplant mortality, and here we analyze the associated complications and causes of death. Prior to receiving high-dose chemotherapy and bone marrow transplantation, 112 patients underwent a psychodynamically oriented psychiatric assessment (the 'FIT' assessment). Mortality and associated complications were ascertained by a retrospective chart review. The results of the 'FIT' assessment correlated with the incidence of complications and death, whether or not the transplant was performed for hematologic or solid organ cancers, or was from an allogeneic or autologous source. Most individuals with a high risk profile died of progressive major organ dysfunction or recurrent/refractory neoplastic disease in the first year after transplant. We propose that such a psychiatric assessment might identify a subgroup of individuals in whom pre-emptive therapeutic interventions could be most effective. Keywords: bone marrow transplantation; multiorgan failure; personality assessment; risk assessment; leukemia/lymphoma; cancer of breast and ovary Bone marrow transplantation can reverse the myelotoxicity of high-dose radiation and chemotherapy used in many current strategies to treat cancer. However, sepsis and hemorrhage before engraftment, acute and chronic graftversus-host disease, graft rejection, and late organ dysfunction still limit its effectiveness. 1 Thus, an understanding of predisposing factors that place an individual at risk for such difficulties might enable better control and prevention, and ultimately improve survival.
Psychological Distress Among Adult Patients Being Evaluated for Bone Marrow Transplantation
Psychosomatics, 1997
A sample of 437 patients being evaluated for bone marrow transplantation (BMT) complered interviews and questionnaires to assess their psychosocial adjustment. Nearly a third of the patients (3/%) showed some degree ofdepression on the Center for Epidemiologic Studies Depression Scale. Scores on the Profile of Mood States Scale also indicated that these BMT candidates were experiencing a high level ofpsychological distress. This distress was found to be predicted by low scores on the Self-Rated Kama/sky Performance Scale and on scales measuring mastery and dispositional opti• mism. The value ofassessing the levels ofpsychological distress and psychosocial resources ofpatients being evaluated for BMT and/or providing necessary psychiatric interventions are discussed.
The International Journal of Psychiatry in Medicine, 1999
Objective: To seek possible relationships between psychological factors and survival after an intensive medical therapy, using bone marrow transplantation as a model. Method: Candidates for bone marrow transplantation underwent two to three psychodynamically-oriented psychiatric interviews that explored family functioning (“ F”), individual psychological maturity (“ I”), and the capacity to form and communicate a mature psychological construct of the transplant (“ T”) process. The results were recorded in a semi-quantitative manner, assigning a possible score of 1 to 3 for each parameter, for a possible total of 3 to 9 (the “ F.I.T.” assessment). Survival after the transplant was analyzed retrospectively in relation to the F.I.T. assessment. Results: In a series of 112 candidates interviewed prior to transplant, those with the lowest F.I.T. assessment tended not to survive as long. By one year, 95 percent of individuals assigned the lowest score (F.I.T. = 3) had died, whereas 96 per...
Bone Marrow Transplantation, 1998
The purpose of this study was to measure the trajectory of psychosocial recovery over the first year after bone marrow transplantation (BMT). BMT patients were assessed at baseline (n = 86), hospital discharge (n = 74), 100 days (n = 64) and at 1 year (n = 45). Participants completed the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale (FACT-BMT), the Profile of Mood States Total Mood Disturbance Scale (POMS-TMDS), the Medical Outcomes Social Support Survey (MOS-SSS), the Center for Epidemiologic Studies-Depression (CES-D) scale screener, a performance Status Rating Scale (PSR), and an interview questionnaire. The recovery trajectory in this patient population showed three distinct trends. The trajectory for distress was linear and improved over time with approximately 20% of patients continuing to have psychological distress at 1 year. Secondly, the trend for overall quality of life was parabolic, worsening at discharge, then improving at 100 days and at 1 year. However, there were individual areas of deficit at follow-up, eg fatigue, even while overall quality of life mean scores improved. Thirdly, the trend for patient concerns over time was linear and worsening. These recovery trajectories suggest psychosocial interventions before and after BMT that may prepare patients for increasing and worsening concerns even as physical well-being improves.
Psychological adaptation and symptom distress in bone marrow transplant recipients
Psycho-Oncology, 1996
This prospective study was designed to measure changes in the psychological status, self-esteem, dependence on other people, physical symptom distress and coping during isolation for bone marrow transplantation (BMT). A sample of 26 BMT patients was assessed at four different points in time. Results indicated that high psychological morbidity was present the day before the transplant, which remained elevated throughout hospitalisation and even a month after discharge. Main distressing symptoms included changes in bowel patterns. fatigue, insomnia, poor appetite and poor concentration. Tension-anxiety and depression showed a non-significant decrease throughout hospitalisation, but anger-hostility and fatigue were increased, especially in the last assessment about a month after discharge from hospital. Activity levels declined over time. Dependence on others and self-esteem have shown no significant changes over time, although pre-transplant assessment showed low self-esteem and a high degree of dependence on others. Main coping mechanisms during isolation identified in the study were hope, directing attention, maintaining control over the situation and acceptance. Psychological disturbance during isolation had a 'carry-over' effect even a month after discharge from hospital. Higher symptom distress was associated with higher mood disturbance. Different types of isolation during BMT were not associated with differential amounts of psychomorbidity. Finally, patients who received professional psychological support during BMT demonstrated significantly lower mood disturbance compared with patients who did not receive psychological support.
Psychological functioning and quality of life following bone marrow transplantation
Journal of Psychosomatic Research, 2000
To assess changes in quality of life and psychological distress following bone marrow transplantation (BMT) and variables related to this change. One hundred twenty-five consecutive patients who underwent bone marrow transplantation (BMT) at the Leiden University Medical Centre between 1987 and 1992 filled in questionnaires measuring quality of life, functional limitations, psychological distress, anxiety, depression, self-esteem, and health locus of control. Measurements were taken before the BMT; 1 month after discharge; and 6 months, 1 year, and 3 years after the BMT. Three years after BMT, a quarter of the patients continued to experience serious functional limitations. Thirteen percent of the patients scored >4 on the General Health Questionnaire (GHQ-12), a percentage comparable to general population prevalence. Quality of life was reported to be good to excellent by almost 90% of the patients at three years. Changes in quality of life could be explained entirely by changes in functional limitations and somatic symptoms. Changes in psychological distress were also related to these measures, and furthermore to baseline psychological functioning. Although patients were doing well three years after BMT, there was a group of patients needing help. In interventions special attention should be given to patients with ongoing psychological problems. Emphasis should be on coping with physical limitations.
International Journal of Behavioral Medicine, 1999
This study investigated the utility of 3 pretransplant psychological variables (affective functioning, compliance, social support stability) in predicting subsequent bone marrow transplantation (BMT) health outcomes. The pre-BMT psychological evaluations of 92 BMT recipients were coded along the specified psychological dimensions and used to predict post-BMT survival status and health-related quality of life. Data analyses showed that, in addition to medical risk status (low) and quality of the marrow graft (histocompatible), higher levels of pre-BMT affective functioning and social support stability significantly predicted survival status (i.e., alive) and higher levelsof quality of life. These findings have important implications for the role of psychological assessment prior to BMT and the need for interventions designed to enhance psychological functioning and subsequent health outcomes following BMT.
Indian Journal of Hematology and Blood Transfusion, 2023
Background: Hematopoietic stem cell transplantation (HSCT) is an established treatment for a number of malignancies. Quality of life (QOL) is an important marker for assessing arduous treatment modalities. Diagnosis of cancer, HSCT, and the physical and psychosocial sequelae of the intensive treatment lead to a deficit in the QOL of the recipient. This study aimed to assess the impact of HSCT on psychiatric morbidity and QOL in patients with hematological malignancies. Methods: A longitudinal pre-post study was conducted at a cancer research center. Thirty patients with hematological malignancies were assessed at three different time points for psychiatric symptoms and QOL. Sociodemographic and clinical variables were collected using a semi-structured questionnaire. Comprehensive psychopathological rating scale was used to assess the psychiatric symptoms. WHO QOL Bref and cancer-specific European Organisation for Research and Treatment of Cancer Quality of life Questionnaire (EORTC-QLQ) were used to measure the quality of life. Results: The mean (SD) age of the sample was 42.3 (12.8) years, with 24 males and 6 females. Most patients reported anxiety and depressive symptoms, reaching a peak at 3 week post-HSCT. The maximum deficit in QOL scores was seen at 3 weeks, with further improvement at 3-month post-transplant. Conclusions: HSCT leads to an increase in symptoms and a decrease in QOL during the acute phase. In the long run, it leads to improvement in physical and psychological wellbeing, with improvement in QOL. The recent surge in the long-term survivors of the procedure calls for further research in this direction so as to aid in their full recovery.