Abstract

Background/Purpose: Effective symptom assessment and management for children with advanced cancer undergoing hematopoietic stem cell transplantation (HSCT) is critical to minimize suffering. The purpose of this subanalysis was to compare feasibility of electronic data collection data and symptom prevalence, frequency, severity, and distress from children with advanced cancer undergoing HSCT with a non-HSCT cohort. Method: An abbreviated Pediatric Quality of Life and Evaluation of Symptoms Technology Memorial Symptom Assessment Scale was electronically administered every 2 weeks to children with advanced cancer. A subanalysis was conducted for the cohort of children who received autologous or allogeneic HSCT. Results: Forty-six participants completed 563 symptom assessments during the study. However, 11 of these 46 children received HSCT and completed 201 symptom assessments. The median age in the HSCT cohort was 12.7 years, 73% were female, and most children had a hematologic (45%) or solid tumor (45%) malignancy. Pain (35%), nausea (30%), sleeping difficulty (29%), and fatigue (22%) were the most commonly reported symptoms in children receiving HSCT. Children in the HSCT cohort had similar total, subscale, and individual symptom scores compared with children who did not receive HSCT. Certain domains of gastrointestinal symptoms (nausea, lack of appetite, and diarrhea) were higher for children receiving HSCT compared with children with advanced cancer not receiving HSCT (p < .05). Conclusion: Elicitation of patient-reported symptom experiences using electronic methods improves nurses' understanding of the symptom experience for children with advanced cancer undergoing HSCT and may promote timely assessment and treatment of distressing symptoms.

Abstract

PURPOSE The aim of this study was to determine effectiveness of an individual exercise program by starting before hematopoietic stem cell transplantation (HSCT) and continued with home exercise program after discharge up to 100 days after transplantation. METHODS Totally, 50 patients were included in this study, and participants were assigned to two groups as intervention group (IG, n = 25) and control group (CG, n = 25). Participants were assessed at three time points: before HSCT, at the discharge, and at the 100th day after HSCT. Functional exercise capacity, physical functions, muscle strength, cognitive functions, quality of life, fatigue, and emotional status of the individuals were assessed. For IG, aerobic, muscle strengthening, endurance, and stretching exercises were performed through hospitalization, and an individual exercise and walking program was advised as home exercise program after discharge. RESULTS Peripheral muscle strength and quality of life level was higher in IG than CG as a result of inpatient supervised exercise program (p < 0.05). At the 100th day, positive effects of the home exercise program on cardiopulmonary exercise capacity, peripheral muscle strength, quality of life, and fatigue level continued when compared with CG (p < 0.05). CONCLUSION As a result of our study, an exercise program continued up to 100 days after HSCT which is individual and partly supervised by a physiotherapist has positive effects on physical functions, clinical status, fatigue, and quality of life level throughout HSCT. Exercise programs for individuals undergoing HSCT should be performed day by day according to the patients' daily clinical and hematologic status and their performance capacity.

Abstract

BACKGROUND Patients undergoing hematopoietic stem cell transplantation (HSCT) require extensive care, and their caregivers were previously found to experience high levels of caregiver's burden. However, the current status of HSCT patient caregiver burden in Suzhou, China, is still unknown. OBJECTIVE To investigate the current status of caregiver burden among family caregivers of HSCT patients from Suzhou, China, and explore the related factors of caregiver burden. METHODS This cross-sectional study enrolled 116 HSCT patient-caregiver dyads. The following measurement tools were used: a demographic questionnaire, Zarit Burden Interview, and World Health Organization Quality of Life questionnaire (brief version). Multiple regression model was used to analyze the factors associated with caregiver burden, and the relationship between caregiver burden and quality of life was analyzed. RESULTS Caregivers' marital status, family monthly income, duration of caregiving, daily caregiving time, other cocaregivers, transplant-related complications, and relapse were closely related to caregiver burden, and 75.4% of the variance in caregivers' burden was explained by these factors. A negative correlation between caregiver burden and quality of life was noted. CONCLUSION The HSCT patient caregivers' burden noted in this study was higher than that found in previous studies. The quality of life of HSCT patient caregivers is lower than that of the average Chinese population and decreases with a greater sense of burden. IMPLICATIONS FOR PRACTICE Hematopoietic stem cell transplantation patient caregivers should be given appropriate social support to reduce their burden of care. Factors identified in this study may help center future intervention programs on caregivers who need help the most.

Abstract

Enteral Nutrition (EN) is recommended as first line nutritional support for patients undergoing Allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT), but only few studies exist in the literature which compare EN to Parenteral Nutrition (PN) in the paediatric population.Forty-two consecutive paediatric patients undergoing allo-HSCT at our referral centre between January 2016 and July 2019 were evaluated. Post-transplant and nutritional outcomes of patients receiving EN for more than 7 days (EN group, n = 14) were compared with those of patients receiving EN for fewer than 7 days or receiving only PN (PN group, n = 28). In the EN group, a reduced incidence of Blood Stream Infections (BSI) was observed (p = 0.02) (n = 2 vs. n = 15; 14.3% vs. 53.6%). The type of nutritional support was also the only variable independently associated with BSI in the multivariate analysis (p = 0.03). Platelet engraftment was shorter in the PN group than in the EN group for a threshold of > 20*10(9)/L (p = 0.04) (23.1 vs 35.7 days), but this correlation was not confirmed with a threshold of > 50*10(9)/L. The Body Mass Index (BMI) and the BMI Z-score were no different in the two groups from admission to discharge.Our results highlight that EN is a feasible and nutritionally adequate method of nutritional support for children undergoing allo-HSCT in line with the present literature. Future functional studies are needed to better address the hypothesis that greater intestinal eubyosis maintained with EN may explain the observed reduction in BSI.

Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) is a life-saving technology that can cure otherwise incurable diseases, but imposes significant physiologic stress upon recipients. This stress leads to short-term toxicity and mid- to long-term physical function impairment in some recipients. Exercise interventions have demonstrated preliminary efficacy in preserving physical function in HCT recipients, but the role of these interventions prior to HCT (prehabilitative) is less known. We tested a 5- to 12-week, prehabilitative higher intensity home-based aerobic exercise intervention in a randomized study of alloHCT candidates. Of 113 patients screened, 34 were randomized to control or intervention groups, 16 underwent pre- and post-intervention peak oxygen consumption (VO2peak) testing, and 12 underwent pre- and post-intervention 6-min walk distance (6MWD) testing. No significant differences in VO2peak or 6MWD were seen pre- to post-intervention between intervention and control groups, but final numbers of evaluable participants in each group were too small to draw inferences regarding the efficacy of the intervention. We conclude that the design of our prehabilitative intervention was not feasible in this pilot randomized study, and make recommendations regarding the design of future exercise intervention studies in alloHCT.

Abstract

BACKGROUND Hematopoietic stem cell transplantation (HSCT) has become the standard treatment for many diseases, but it is an intense and distinctive experience for patients. HSCT-related mortality is present throughout the whole process of transplantation, from pretransplantation to recovery. Long-term rehabilitation and the uncertain risk of death evoke feelings of vulnerability, helplessness, and intense fear. Zimmermann et al. proposed that spiritual well-being is an important dimension of quality of life and that patients at the end stage of life require spiritual support in addition to physical care, psychological care, and social support. Therefore, the purpose of this review is to examine the role of spirituality in the process of HSCT. METHOD A systematic mixed studies review (SMSR) was based on Pluye and Hong's framework to understand the role of spirituality in patients' experiences while undergoing HSCT. We use the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement to report the results of integration. RESULTS Fifteen original qualitative studies, 19 quantitative studies, and one mixed method study were included in the systematic mixed studies review. The evidence from the review revealed the following three themes: the spiritual experiences of HSCT patients, the spiritual coping styles of HSCT patients, and the spiritual need changes brought about by HSCT. DISCUSSION Few medical institutions currently offer spiritual healing, although HSCT patients with different cultural backgrounds may have different spiritual experiences and spiritual coping styles. Psychotherapists or nurses should be considered to provide spiritual care for patients undergoing HSCT, to help patients cope with disease pressures, promote HSCT patients' comfort, and improve their quality of life.

Abstract

BACKGROUND Hematopoietic cell recipients are reported to have a high prevalence of depression and anxiety. The impact of depression and anxiety on opioid use has not been well characterized. This is of significance as the opioid epidemic continues, and over 60% of deaths secondary to drug overdose involve the use of opioids. OBJECTIVE In this retrospective, single-center study of 275 patients who underwent hematopoietic cell transplantation (HCT) (allogeneic and autologous) for hematological malignancies, we explore the impact of depression and anxiety on opioid use. RESULTS Patients who were both anxious and depressed at admission for HCT had increased odds of receiving an opioid (odds ratio of 4.50 [95% confidence interval: 1.75, 11.56]) compared with patients who were neither depressed nor anxious. However, patients who were either depressed or anxious did not have different odds of receiving an opioid compared with those who were neither depressed nor anxious. Autologous HCT recipients had reduced odds of receiving an opioid (odds ratio of 0.17 [95% confidence interval: 0.08, 0.38]) compared with patients undergoing allogeneic HCT. Patients with lower Karnofsky performance status (<90 on a scale of 1-100) had an increased incidence of receiving a higher Morphine milligram equivalent daily dosage (incidence rate ratio of 2.59 [95% confidence interval: 1.18, 5.67]) when modeled by zero truncated negative binomial regression. CONCLUSION Presence of depression and anxiety impacts opioid use in patients undergoing HCT.

Abstract

PURPOSE To update the guideline to include new anticancer agents, antiemetics, and antiemetic regimens and to provide recommendations on the use of dexamethasone as a prophylactic antiemetic in patients receiving checkpoint inhibitors (CPIs). METHODS ASCO convened an Expert Panel and updated the systematic review to include randomized controlled trials (RCTs) and meta-analyses of RCTs published between June 1, 2016, and January 24, 2020. To address the dexamethasone and CPI question, we conducted a systematic review of RCTs that evaluated the addition of a CPI to chemotherapy. RESULTS The systematic reviews included 3 publications from the updated search and 10 publications on CPIs. Two phase III trials in adult patients with non-small-cell lung cancers evaluating a platinum-based doublet with or without the programmed death 1 (PD-1) inhibitor pembrolizumab recommended that all patients receive dexamethasone as a component of the prophylactic antiemetic regimen. In both studies, superior outcomes were noted in the PD-1 inhibitor-containing arms. Other important findings address olanzapine in adults and fosaprepitant in pediatric patients. RECOMMENDATIONS Recommendations for adults are unchanged with the exception of the option of adding olanzapine in the setting of hematopoietic stem cell transplantation. Dosing information now includes the option of a 5-mg dose of olanzapine in adults and intravenous formulations of aprepitant and netupitant-palonosetron. The option of fosaprepitant is added to pediatric recommendations. There is no clinical evidence to warrant omission of dexamethasone from guideline-compliant prophylactic antiemetic regimens when CPIs are administered to adults in combination with chemotherapy. CPIs administered alone or in combination with another CPI do not require the routine use of a prophylactic antiemetic.Additional information is available at www.asco.org/supportive-care-guidelines.

Abstract

In 2015, we implemented an at-home allogeneic haematopoietic cell transplant (allo-HCT) program. Between 2015 and 2018, 252 patients underwent allo-HCT; 41 patients underwent allo-HCT in the at-home program (46% myeloablative; 63% unrelated donor; 32% posttransplant cyclophosphamide), and these patients were compared with 39 in-patients; safety, capacity to release beds for other programs, and economic efficiency cost were evaluated. We observed a lower incidence of febrile neutropenia in the at-home group compared with that in the in-patient group (32% versus 90%; p < 0.0001), whereas the incidence of aspergillosis was similar among groups (at-home 1% versus in-patient 3%; p = 0.5). The at-home patients showed a lower incidence of 1-year severe graft-versus-host disease (GVHD; 10% versus 29%; p = 0.03). There were no differences in 1-year transplant-related mortality, relapse, or overall survival among groups. The re-admission rate in the at-home group was 7%. The at-home setting was less expensive (9087 euro/transplant), and its implementation increased capacity by 10.5 allo-HCTs/year. Moreover, a chimeric antigen receptor T-cell program could be established without increasing beds. Thus, our at-home allo-HCT program may be a safe modality to reduce febrile neutropenia and acute GVHD, resulting in lower re-admission rates.

Abstract

Central venous catheters (CVC) are extensively used in patients undergoing allogeneic hematopoietic cell transplantation (HCT). In these patients CVC are placed routinely either via the internal jugular vein (IJV) or the subclavian vein (SCV). Purpose of this study was to analyze systematically complications of CVC at different insertion sites in HCT patients. In this retrospective analysis, all consecutive patients (n=56) who received a CVC (n=101) due to allogeneic HCT at our institution from 01/2011 to 06/2013 were included. 3-lumen standard non-tunneled CVC were placed either via the IJV (n=60, 59%) or the SCV (n=41, 41%). Study end points were time to local inflammation at the insertion site and time to fever and a combined endpoint of both variables, central line associated blood stream infections (CLABSI), duration of catheterization, catheter lumen obstruction, deep-vein thrombosis, pneumothorax and catheter-related deaths. The median duration of catheterization per CVC was almost identical for the IJV and the SCV (18 vs. 17 days, ns.). There were no differences in the frequency of CLABSI, deep-vein thrombosis, pneumothorax and catheter lumen obstruction between IJV and SCV-CVC. None of the patients died CVC-related. Local inflammation occurred less frequently (48% vs. 71%, p=0.025) and later (median time to local inflammation 25 vs. 12 days, p=0.01) in IJV vs. SCV-CVCs. There was a trend towards a longer duration until the occurrence of fever for IJV-CVC (20 days) in comparison to SCV-CVC (13 days, p=0.07). In the multivariate analysis, diagnosis of acute leukemia (HR 1.696, p=0.036), SCV-CVC (HR 1.617, p= 0.039) and neutropenic CVC-days (HR 2.477, p=0.01) were identified as risk factors for the occurrence of local inflammation or fever. In contrast to earlier studies on patients without hematologic malignancies, these data demonstrate that CVC placed in the SCV are not superior over IJV-CVC. Moreover, local inflammation occurred earlier and more frequently in patients with SCV-CVC.