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Financial hardship in childhood cancer survivors treated with hematopoietic cell transplant: A report from the Childhood Cancer Survivor Study
Buchbinder, D., Bhatt, N. S., Wang, H., Yasui, Y., Armenian, S., Bhatia, S., Chow, E. J., Huang, I. C., Kirchoff, A. C., Leisenring, W., et al
Transplantation and cellular therapy. 2023
Abstract
BACKGROUND Long-term survivors of childhood cancer are at risk for financial hardship. However, it is not known if HCT leads to an incremental change in financial hardship for survivors who received it vs. those who did not. We examined financial outcomes among adult survivors of childhood cancer who had undergone HCT. METHODS Using a cross-sectional survey in the Childhood Cancer Survivor Study population between 2017-2019, self-reported financial hardship was compared between survivors who received HCT, survivors treated without HCT ("non-HCT"), and siblings and categorized into 3 domains (material hardship/financial sacrifices, behavioral, and psychological hardship). The standardized score of each domain of financial hardship was calculated by adding the item responses and dividing by the standard deviation among siblings. Multivariable linear and logistic regression evaluated associations between socio-demographics, cancer diagnosis, post-treatment complications and financial hardship among survivors. RESULTS Mean adjusted score for each hardship domain among HCT survivors (n=133) was not significantly different from non-HCT survivors (n=2711): material hardship/financial sacrifices (mean difference 0.18, 95% confidence interval [CI] [-0.05, 0.41]), behavioral hardship (0.07, [-0.18, 0.32]), psychological hardship (0.19, [-0.04, 0.42]). Within specific items, a higher proportion of survivors treated with HCT reported greater financial hardship compared to non-HCT survivors. HCT survivors also had significantly higher mean domain scores compared to sibling controls (n=1027) in all domains. Household income and chronic health conditions, but not HCT, were associated with financial hardship among all survivors. CONCLUSIONS Adult survivors of childhood cancer treated with HCT do not report greater overall financial hardship compared to non-HCT survivors; but greater overall financial hardship compared to sibling controls. Surveillance and intervention may be necessary for all survivors regardless of HCT status.
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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.
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Health-related quality of life before and after hematopoietic stem cell transplant: evidence from a survey in Suzhou, China
Liang, Y., Wang, H., Niu, M., Zhu, X., Cai, J., Wang, X.
Hematology (Amsterdam, Netherlands). 2018;:1-7
Abstract
OBJECTIVES The aim of our longitudinal study was to explore changes in HRQOL over a 6-month period and to identify factors associated with the HRQOL of HSCT recipients. METHOD Our study comprised 191 HSCT patients; their data were collected before transplantation and at 30, 90, and 180 days posttransplantation. The Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) questionnaire was used to assess HRQOL.We also evaluated the patients' demographic characteristics and clinical histories to determine the relative contributions of these factors to HRQOL outcomes. RESULTS Before HSCT, the patients reported a mean overall HRQOL of 110.31 (SD, 14.99); this reached a minimum of 105.07 (SD, 18.85) at day 30 after HSCT and increased steadily over time to 106.71 (SD, 18.34) at day 90 and 108.16 (SD, 18.34) at day 180 after HSCT.Compared with baseline, overall HRQOL changed with the mean of -5.24 (SE 1.55; P = .001), and -3.60 (SE 1.55; P = .022), respectively, at 30 days and 90 days after HSCT. Overall HRQOL returned to near pretransplant levels at 180 days after HSCT (SE 1.47; P = .146).Generalized estimating equation (GEE) models showed that household income (beta = 6.590; P < .001), transplant-related complications (beta = -6.101; P < .001), and patient age (beta = 0.243, P = .045) were associated with HRQOL. CONCLUSION The patients' overall HRQOL was severely impaired in the early stages of posttransplantation, and patients experienced the worst HRQOL at 30 days. They had improved significantly by 180 days posttransplantation. We also found that household income, transplant-related complications, and age were independent predictors of early HRQOL.We therefore concluded that the HRQOL of HSCT patients in the early stages posttransplantation deserved more attention.
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Longitudinal Analysis of the Relationships Between Social Support and Health-Related Quality of Life in Hematopoietic Stem Cell Transplant Recipients
Liang, Y., Wang, H., Niu, M., Zhu, X., Cai, J., Wang, X.
Cancer nursing. 2018
Abstract
BACKGROUND The correlation between social support and health-related quality of life (HRQOL) has been well documented, but whether social support changes or whether social support consistently plays a significant role in the various phases of the treatment process remains unknown among hematopoietic stem cell transplantation (HSCT) patients. OBJECTIVES The aims of this study were to assess the changing trends of HRQOL and social support and evaluate the relationship between HRQOL and social support before and after transplantation. METHODS Measures were completed by 122 HSCT patients before and after transplantation. The measures administered included the Perceived Social Support Scale and the Functional Assessment of Cancer Therapy-Bone Marrow Transplant questionnaire. RESULTS The social support score presented a marked downward trend (F = 17.090, P < .001). The overall HRQOL was the lowest, 103.61 (SD, 19.14) at 1 month and increased steadily over time to 108.10 (SD, 19.58) at 3 months and 110.02 (SD, 18.00) at 6 months after HSCT. The generalized estimating equation models showed that social support consistently had a positive impact on HRQOL in the 6-month period post-HSCT. CONCLUSION We confirmed a significant positive association between social support and HRQOL in HSCT recipients. However, it is noteworthy that the social support score declined during the 6-month period even while the HRQOL scores were increasing. IMPLICATIONS FOR PRACTICE Social support is closely related to the HRQOL; thus, clinicians should give close attention to social support to improve the HRQOL of HSCT patients. Social support should not be overlooked during the first 6 months after transplantation.