Skip to main content

Advertisement

SpringerLink
Log in

Measuring musculoskeletal symptoms in cancer survivors who receive hematopoietic cell transplantation

  • Published:
Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Introduction

Beyond documentation of high prevalence rates, research has not examined the qualities and characteristics of musculoskeletal symptoms in cancer survivors, possibly because measures have not been validated specifically for the assessment of these symptoms in survivors. We report here on a new measure of muscle and joint symptoms for survivors of hematologic malignancies and hematopoietic cell transplantation (HCT).

Methods

In a cross-sectional design, 130 adults, 5–20 years after HCT, completed patient-reported outcomes. Assessment included musculoskeletal symptoms on the Muscle and Joint Measure (MJM), as well as health-related quality of life and treatments.

Results

Principal components analysis using promax rotation revealed four subscales for the MJM with item factor loadings above 0.50: muscle aches or stiffness (myalgias), joint pain, stiffness or swelling (arthralgias), muscle cramps, and muscle weakness. Variance explained by the total score was 77%. Internal consistency reliabilities of the subscales and total score ranged from 0.86 to 0.93. Validity was confirmed by correlations with the Short Form-36 bodily pain, physical function and vitality subscales, the Fatigue Symptom Inventory, and the Symptom Checklist-90-R depression (all P < .001).

Conclusions

Musculoskeletal symptoms in survivors who received HCT can be measured reliably and validly with the MJM. The measure requires testing to establish its psychometric properties with other diagnostic and treatment groups.

Implications for Cancer Survivors

The MJM has potential research and clinical value for addressing the musculoskeletal symptoms of survivors. The measure may assist with examining the mechanisms as well as treatments for these symptoms, which are among the most prevalent in long-term cancer survivors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Stein KD, Syrjala KL, Andrykowski MA. Physical and psychological long-term and late effects of cancer. Cancer. 2008;112:2577–92.

    Article  PubMed  Google Scholar 

  2. Ganz PA, Rowland JH, Desmond K, Meyerowitz BE, Wyatt GE. Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. J Clin Oncol. 1998;16:501–14.

    CAS  PubMed  Google Scholar 

  3. Nieboer P, Buijs C, Rodenhuis S, Seynaeve C, Beex LVAM, van der Wall E, et al. Fatigue and relating factors in high-risk breast cancer patients treated with adjuvant standard or high-dose chemotherapy: a longitudinal study. J Clin Oncol. 2005;23:8296–304.

    Article  CAS  PubMed  Google Scholar 

  4. Gurney JG, Ness KK, Rosenthal J, Forman SJ, Bhatia S, Baker KS. Visual, auditory, sensory, and motor impairments in long-term survivors of hematopoietic stem cell transplantation performed in childhood: results from the Bone Marrow Transplant Survivor study. Cancer. 2006;106:1402–8.

    Article  PubMed  Google Scholar 

  5. Ness KK, Baker KS, Dengel DR, Youngren N, Sibley S, Mertens AC, et al. Body composition, muscle strength deficits and mobility limitations in adult survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2007;49:975–81.

    Article  PubMed  Google Scholar 

  6. Adams C, August CS, Maguire H, Sladky JT. Neuromuscular complications of bone marrow transplantation. Pediatr Neurol. 1995;12:58–61.

    Article  CAS  PubMed  Google Scholar 

  7. Syrjala KL, Langer SL, Abrams JR, Storer BE, Martin PJ. Late effects of hematopoietic cell transplantation among 10-year adult survivors compared with case-matched controls. J Clin Oncol. 2005;23:6596–606.

    Article  PubMed  Google Scholar 

  8. Bush NE, Haberman M, Donaldson G, Sullivan KM. Quality of life of 125 adults surviving 6–18 years after bone marrow transplantation. Soc Sci Med. 1995;40:479–90.

    Article  CAS  PubMed  Google Scholar 

  9. Kovalszki A, Schumaker GL, Klein A, Terrin N, White AC. Reduced respiratory and skeletal muscle strength in survivors of sibling or unrelated donor hematopoietic stem cell transplantation. Bone Marrow Transplant. 2008;41:965–9.

    Article  CAS  PubMed  Google Scholar 

  10. Syrjala KL, Langer SL, Abrams JR, Storer B, Sanders JE, Flowers MED, et al. Recovery and long-term function after hematopoietic cell transplantation for leukemia or lymphoma. JAMA. 2004;291:2335–43.

    Article  CAS  PubMed  Google Scholar 

  11. Baker KS, Gurney JG, Ness KK, Bhatia R, Forman SJ, Francisco L, et al. Late effects in survivors of chronic myeloid leukemia treated with hematopoietic cell transplantation: results from the bone marrow transplant survivor study. Blood. 2004;104:1898–906.

    Article  CAS  PubMed  Google Scholar 

  12. Andrykowski MA, Bishop MM, Hahn EA, Cella DF, Beaumont JL, Brady MJ, et al. Long-term health-related quality of life, growth, and spiritual well-being after hematopoietic stem-cell transplantation. J Clin Oncol. 2005;23:599–608.

    Article  PubMed  Google Scholar 

  13. White AC, Terrin N, Miller KB, Ryan HF. Impaired respiratory and skeletal muscle strength in patients prior to hematopoietic stem-cell transplantation. Chest. 2005;128:145–52.

    Article  PubMed  Google Scholar 

  14. Hovi L, Era P, Rautonen J, Siimes MA. Impaired muscle strength in female adolescents and young adults surviving leukemia in childhood. Cancer. 1993;72:276–81.

    Article  CAS  PubMed  Google Scholar 

  15. Cleeland CS, Mendoza TR, Wang XS, Chou C, Harle MT, Morrissey M, et al. Assessing symptom distress in cancer patients: the M.D. Anderson symptom inventory. Cancer. 2000;89:1634–46.

    Article  CAS  PubMed  Google Scholar 

  16. Velikova G, Weis J, Hjermstad MJ, Kopp M, Morris P, Watson M, et al. The EORTC QLQ-HDC29: a supplementary module assessing the quality of life during and after high-dose chemotherapy and stem cell transplantation. Eur J Cancer. 2007;43:87–94.

    Article  CAS  PubMed  Google Scholar 

  17. Ware JE, Kosinski M, Dewey JE. How to score version 2 of the SF-36 health survey. Lincoln: QualityMetric Incorporated; 2000.

    Google Scholar 

  18. Ware JE, Snow KK, Kosinski M. SF-36 health survey: manual and interpretation guide. Boston: The Health Institute, New England Medical Center; 1997.

    Google Scholar 

  19. Laird BJ, Boyd AC, Colvin LA, Fallon MT. Are cancer pain and depression interdependent? A systematic review. Psycho-Oncology. 2009;18:459–64.

    Article  PubMed  Google Scholar 

  20. Syrjala KL, Kurland BF, Abrams JR, Sanders JE, Heiman JR. Sexual function changes during the 5 years after high-dose treatment and hematopoietic cell transplantation for malignancy, with case-matched controls at 5 years. Blood. 2008;111:989–96.

    Article  CAS  PubMed  Google Scholar 

  21. Sutherland HJ, Fyles GM, Adams G, Hao Y, Lipton JH, Minden MD, et al. Quality of life following bone marrow transplantation: a comparison of patient reports with population norms. Bone Marrow Transplant. 1997;19:1129–36.

    Article  CAS  PubMed  Google Scholar 

  22. McHorney CA, Ware Jr JE, Raczek AE. The MOS 36-item short-form health survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31:247–63.

    Article  CAS  PubMed  Google Scholar 

  23. Hann DM, Jacobsen PB, Azzarello LM, Martin SC, Curran SL, Fields KK, et al. Measurement of fatigue in cancer patients: development and validation of the fatigue symptom inventory. Qual Life Res. 1998;7:301–10.

    Article  CAS  PubMed  Google Scholar 

  24. Hann DM, Denniston MM, Baker F. Measurement of fatigue in cancer patients: further validation of the fatigue symptom inventory. Qual Life Res. 2000;9:847–54.

    Article  CAS  PubMed  Google Scholar 

  25. Mulrow CD, Williams JW, Gerety MB, Ramirez G, Montiel OM, Kerber C. Case-finding instruments for depression in primary care settings. Ann Intern Med. 1995;122:913–21.

    CAS  PubMed  Google Scholar 

  26. Sapnas KG, Zeller RA. Minimizing sample size when using exploratory factor analysis for measurement. J Nurs Meas. 2002;10:135–54.

    Article  PubMed  Google Scholar 

  27. Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale: Lawrence Erlbaum Associates; 1988.

    Google Scholar 

  28. Catell RB. The scree test for number of factors. Multivariate Behav Research. 1966;1:245–76.

    Article  Google Scholar 

  29. Patrick DL, Ferketich SL, Frame PS, Harris JJ, Hendricks CB, Levin B, et al. National institutes of health state-of-the-science conference statement: symptom management in cancer: pain, depression, and fatigue, July 15–17, 2002. J Natl Cancer Inst. 2004;Monographs.:9–16.

  30. Wang XS. Pathophysiology of cancer-related fatigue. Clin J Oncol Nurs. 2008;12:11–20.

    Article  PubMed  Google Scholar 

  31. Cleeland CS, Bennett GJ, Dantzer R, Dougherty PM, Dunn AJ, Meyers CA, et al. Are the symptoms of cancer and cancer treatment due to a shared biologic mechanism: a cytokine-immunologic model of cancer symptoms. Cancer. 2003;97:2919–25.

    Article  PubMed  Google Scholar 

  32. Bower JE, Ganz PA, Aziz N, Fahey JL. Fatigue and proinflammatory cytokine activity in breast cancer survivors. Psychosom Med. 2002;64:604–11.

    PubMed  Google Scholar 

  33. Bower JE, Ganz PA, Aziz N, Fahey JL, Cole SW. T-cell homeostatis in breast cancer survivors with persistent fatigue. J Natl Cancer Inst. 2003;95:1165–8.

    Article  PubMed  Google Scholar 

  34. Felson DT, Cummings SR. Aromatase inhibitors and the syndrome of arthralgias with estrogen deprivation. Arthritis Rheum. 2005;52:2594–8.

    Article  CAS  PubMed  Google Scholar 

  35. Deininger MW, O’Brien SG, Ford JM, Druker BJ. Practical management of patients with chronic myeloid leukemia receiving imatinib. J Clin Oncol. 2003;21:1637–47.

    Article  CAS  PubMed  Google Scholar 

  36. Schneider CM, Hsieh CC, Sprod LK, Carter SD, Hayward R. Cancer treatment-induced alterations in muscular fitness and quality of life: the role of exercise training. Ann Oncol. 2007;18:1957–62.

    Article  CAS  PubMed  Google Scholar 

  37. van Weert E, Hoekstra-Weebers J, Grol B, Otter R, Arendzen HJ, Postema K, et al. A multidimensional cancer rehabilitation program for cancer survivors: effectiveness on health-related quality of life. J Psychosom Res. 2005;58:485–96.

    Article  PubMed  Google Scholar 

  38. Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol. 2007;25:4396–404.

    Article  PubMed  Google Scholar 

  39. Winett RA, Carpinelli RN. Potential health-related benefits of resistance training. Prev Med. 2001;33:503–13.

    Article  CAS  PubMed  Google Scholar 

  40. van Weert E, Hoekstra-Weebers JE, May AM, Korstjens I, Ros WJ, van der Schans CP. The development of an evidence-based physical self-management rehabilitation programme for cancer survivors. Patient Educ Couns. 2008;71:169–90.

    Article  PubMed  Google Scholar 

  41. Jinks C, Jordan K, Croft P. Measuring the population impact of knee pain and disability with the Western Ontario and McMaster Universities Osteoarthritis Index. Pain. 2005;100:55–64.

    Article  Google Scholar 

  42. Fransen J, van Riel PL. Outcome measures in inflammatory rheumatic diseases. Arthritis Res Ther. 2009;11:244. Review.

    Article  PubMed  Google Scholar 

  43. Pincus T, Yazici Y, Bergman M. Development of a multi-dimensional health assessment questionnaire (MDHAQ) for the infrastructure of standard clinical care. Clin Exp Rheumatol. 2005;23:S19–28.

    CAS  PubMed  Google Scholar 

  44. Pincus T, Askanase AD, Swearingen CJ. A multi-dimensional health assessment questionnaire (MDHAQ) and routine assessment of patient index data (RAPID3) scores are informative in patients with all rheumatic diseases. Rheum Dis Clin N Am. 2009;35:819–27.

    Article  Google Scholar 

  45. Chiari-Grisar C, Koller U, Stamm TA, Wanivenhaus A, Trieb K. Performance of the disabilities of the arm, shoulder and hand outcome questionnaire and the Moberg picking up test in patients with finger joint arthroplasty. Arch Phys Med Rehabil. 2006;87:203–6.

    Article  PubMed  Google Scholar 

  46. Sautner J, Andel I, Rintelen B, Leeb BF. Development of the M-SACRAH, a modified, shortened version of SACRAH (Score for the assessment and quantification of chronic rheumatoid affections of the hands). Rheumatology. 2004;43:1409–13.

    Article  CAS  PubMed  Google Scholar 

  47. Uhlig T, Haavardsholm EA, Kvien TK. Comparison of the health assessment questionnaire (HAQ) and the modified HAQ (MHAQ) in patients with rheumatoid arthritis. Rheumatology. 2006;45:454–8.

    Article  CAS  PubMed  Google Scholar 

  48. Stamm T, Mathis M, Aletaha D, Kloppenburg M, Machold K, Smolen J. Mapping hand functioning in hand osteoarthritis: comparing self-report instruments with a comprehensive hand function test. Arthritis Rheum. 2007;57:1230–7.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful to the survivors who extended themselves to participate in this study. Support for this research was provided by grants CA103728 from the National Cancer Institute and National Institute on Aging, CA112631 from the National Cancer Institute, and a private donation from Robert E. Frey.

Author information

Authors and Affiliations

  1. Biobehavioral Sciences Department, Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D5-220, PO Box 19024, Seattle, WA, 98109, USA

    Karen L. Syrjala, Jean C. Yi, Samantha B. Artherholt, Allison C. Stover & Janet R. Abrams

  2. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA

    Karen L. Syrjala

Authors
  1. Karen L. Syrjala
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean C. Yi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samantha B. Artherholt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Allison C. Stover
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Janet R. Abrams
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karen L. Syrjala.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Syrjala, K.L., Yi, J.C., Artherholt, S.B. et al. Measuring musculoskeletal symptoms in cancer survivors who receive hematopoietic cell transplantation. J Cancer Surviv 4, 225–235 (2010). https://doi.org/10.1007/s11764-010-0126-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-010-0126-x

Keywords

Search

Navigation