1.
Health-Related Quality of Life Outcomes in Older Hematopoietic Cell Transplant (HCT) Survivors
Hong, S., Zhao, J., Wang, S., Wang, H., Lee, J. H., Farhadfar, N., McGuirk, J. P., Savani, B. N., Shahrukh, H. K., Stiff, P., et al
Transplantation and cellular therapy. 2022
Abstract
BACKGROUND Hematopoietic cell transplantation (HCT) use for older patients has been increasing. Distress, psychosocial functioning, and health-related quality of life (HRQOL) among older HCT survivors is largely unknown. METHODS In this secondary analysis using data from two randomized controlled trials, we analyzed baseline cancer and treatment distress (CTXD) and confidence in survivorship information (CSI) surveys of survivors who were ≥60 years at transplant and alive and disease-free ≥1 year post-autologous or allogeneic HCT. We analyzed associations of these parameters with physical and mental component summary (PCS/MCS) scores of SF-12 and healthcare adherence (HCA) scale, after adjusting for transplant and demographic factors. RESULTS A total of 567 patients were included. Median age at HCT was 65 years, 68% received autologous HCT. Median CTXD score was mild at 0.7, and the highest distress was reported in the "Health Burden" subscale. Median CSI score was moderate-high at 1.4, with the lowest confidence reported in the "Late Effects" subscale. We found a negative Spearman correlation between CTXD and PCS (p= -0.59)/MCS (p= -0.54) and positive Spearman correlation between CSI and PCS (p= 0.23)/MCS (p= 0.30). Median HCA was high at 0.8. Male sex, autologous HCT, increased distress level, and worse CSI were associated with lower use of preventive care. CONCLUSION Older survivors experienced a low level of distress and moderate-high level of CSI at ≥1year post-HCT. As lower distress and higher CSI were associated with improved HRQOL and optimized preventive HCA, CTXD/CSI measures can be used to individualize the care of older adult HCT survivors.
2.
Health Related Quality of Life in Young Adults Survivors of Hematopoietic Cell Transplantation
Rotz, S. J., Yi, J. C., Hamilton, B. K., Wei, W., Preussler, J. M., Cerny, J., Deol, A., Jim, H., Khera, N., Hahn, T., et al
Transplantation and cellular therapy. 2022
Abstract
BACKGROUND Young adults, age 18-39, are at a stage of life which may make them more vulnerable than older adults to impairments in health-related quality of life (HRQOL) during and after hematopoietic cell transplantation (HCT). Health self-efficacy (HSE) is the belief that one can implement strategies to produce a desired health outcome and has been associated with health outcomes in oncology research. Little is known about HRQOL or HSE in young adult HCT survivors compared to older HCT survivors. OBJECTIVE Given the age-specific psychosocial challenges facing young adult HCT recipients and research on non-transplant young adult cancer survivors, we hypothesized that young adult survivors would have worse post-HCT HRQOL compared to older adults and that among young adult HCT survivors, higher levels of HSE would be associated with higher HRQOL and lower levels of cancer-related distress. STUDY DESIGN This is a cross-sectional secondary analysis of two combined baseline datasets from multi-center studies of HCT survivors approached for participation in clinical trials of survivorship interventions. Participants from 20 transplant centers in the US were 1-10 years post-HCT, ≥18 years of age at the time of study enrollment, had no evidence of disease relapse/progression or subsequent malignancies, and read English adequate to consent and complete assessments. Medical record and patient-reported data were obtained for demographics and HCT-related clinical factors and complications (e.g. total body irradiation, chronic graft-versus-host disease). Participants completed surveys on HRQOL (Short-form [SF]-12), HSE, and Cancer and Treatment Distress (CTXD), which includes six subscales and an overall mean score. SF-12 was calculated for both mental (MCS) and physical (PCS) component scores. Participants were compared between two cohorts: young adults (age 18 to 39 at transplant) and older adults (age ≥40 at transplant). Multiple linear regression analyses determined factors associated with HSE, PCS, MCS and CTXD within young adults. RESULTS In this analysis of N=979 survivors, compared to older adults, young adult participants had lower mental health scores (SF-12 MCS: 48.40 vs. 50.23, P=0.04) and higher cancer-related distress (CTXD: 0.96 vs. 0.85, P=0.04), though better physical health (SF-12 PCS: 48.99 vs. 47.18, P=0.049). Greater overall cancer-related distress was driven by higher levels of uncertainty, financial concern, and medical demand subscales for young adults compared with older adults. Young adults also had lower HSE (2.93 vs. 3.08, P=0.0004). In a multivariate model, HSE was strongly associated with age group (p=0.0005) after adjusting for multiple other transplant related factors. Among young adults, HSE was associated with mental and physical components of the SF-12 and the CTXD, and HSE remained significant after adjusting for other transplant-related factors. CONCLUSIONS Overall, young adult HCT survivors have lower mental health, increased cancer-related distress, and lower levels of HSE compared to older adults. Although the direction of these effects cannot be determined with these data, the strong association between HSE and HRQOL among young adults suggests that targeting interventions to improve HSE may have broad impact on health outcomes.
3.
Return to Work Among Young Adult Survivors of Allogeneic Hematopoietic Cell Transplantation in the United States
Bhatt, N. S., Brazauskas, R., Salit, R. B., Syrjala, K., Bo-Subait, S., Tecca, H., Badawy, S. M., Baker, K. S., Beitinjaneh, A., Bejanyan, N., et al
Transplantation and cellular therapy. 2021
Abstract
BACKGROUND Young adult (YA) survivors of allogeneic hematopoietic cell transplant (HCT) are at risk for late psychosocial challenges, including inability to return to work post-HCT. However, work-related outcomes in this population remain understudied. OBJECTIVES To assess the post-HCT work status of survivors of allogeneic HCT who underwent HCT as YA and analyze the patient-, disease-, and HCT-related factors associated with their work status at 1-year post-HCT. STUDY DESIGN Using the Center for International Blood and Marrow Transplant Research (CIBMTR) data, we described post-HCT work status (full-time, part-time work, unemployed, and medical disability) of YA HCT survivors (N=1365) who underwent HCT between 2008 and 2015. Percentages of work status categories were reported at four timepoints: 6-months, 1-, 2-, and 3-year post-HCT. Percentages of post-HCT work status categories at the 1-year timepoint were also described in relation to survivors' pre-HCT work status categories. Factors associated with 1-year post-HCT work status (full-time or part-time work) were examined using logistic regression. RESULTS From 6 months to 3 years post-HCT, the percentage of survivors working full-time and part-time increased from 18.3% to 50.7%, and from 6.9% to 10.5%, respectively. Of patients in full-time work pre-HCT, 50% were unemployed or on medical disability at 1-year post-HCT. Female sex (Odds ratio [OR] 0.55; 95% confidence interval [CI] 0.40-0.77), HCT-comorbidity index (HCT-CI) score =3 (OR 0.57; 95% CI 0.39-0.82), pre-HCT unemployment (OR 0.37; 95% CI 0.24-0.56), and medical disability (OR 0.44; 95% CI 0.28-0.70), development of grade 3-4 acute graft vs. host disease (OR 0.52; 95% CI 0.34-0.80), and relapse within one-year post-HCT (OR 0.34; 95% CI 0.21-0.56) were associated with lower likelihood of employment at 1-year post-HCT. Compared to myeloablative conditioning with total body irradiation (TBI), myeloablative conditioning without TBI (OR 1.71; 95% CI 1.16-2.53) was associated with higher likelihood of employment at 1-year post-HCT. Graduate school level education (OR 2.47; 95% CI 1.49-4.10) was also associated with higher likelihood of employment at 1-year post-HCT. CONCLUSIONS While the work status among YA HCT survivors continued to improve over time, a substantial subset became or remained unemployed or on medical disability. These findings underscore the need for effective return to work supportive interventions in this population.