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Psychosocial factors predicting survival after allogeneic stem cell transplant

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Abstract

Purpose

A primary aim was to assess the relative contribution of psychological factors, such as anxiety, depression and mental adjustment to cancer, to overall survival outcomes at a median follow-up of 2 years following allogeneic haematopoietic stem cell transplant (HSCT). A secondary aim was to ascertain if demographic, medical and psychosocial factors assessed prior to transplantation were predictors of survival for patients after accounting for post-transplant events.

Method

Between 2005 and 2011, 130 allograft patients completed the Mental Adjustment to Cancer Scale and Brief Symptom Inventory-18 as part of routine psychological assessment before undergoing transplantation. Survival status data were obtained, and predictors of survival status assessed and analysed using Cox-regression models.

Results

Thirteen percent experienced clinical levels of distress pre-transplant. None of the psychological factors predicted post-HSCT survival. In contrast, hierarchical multivariate analysis indicated that post-transplant factors (acute graft-versus-host disease and relapse post-transplant) predicted survival (Chi-square change, p < 0.001). The addition of a series of pre-transplant psychosocial and medical variables further improved the prediction of survival (Chi-square change, p = 0.01). In particular, relationship status (being single) (p = 0.04) and increased somatic symptoms (p = 0.02) pre-transplant were associated with shorter survival. Both variables were not associated with medical factors but were related to increased severity of anxiety and depressive symptoms as well as greater use of helpless-hopelessness and reduced fighting spirit adjustment response.

Conclusions

Despite the significant influence of acute post-transplant factors in predicting survival following allogeneic HSCT, multidisciplinary pre-transplant assessments are important in identifying patients who are likely to experience poorer survival outcomes.

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References

  1. Andrykowski MA, Brady MJ, Henslee-Downey PJ (1994) Psychosocial factors predictive of survival after allogeneic bone marrow transplantation for leukemia. Psychosom Med 56:432–439

    Article  CAS  PubMed  Google Scholar 

  2. Applebaum FR (1996) The use of bone marrow and peripheral blood stem cell transplantation in the treatment of cancer. CA Cancer J Clin 46:142–164

    Article  Google Scholar 

  3. Bonacchi A, Rossi A, Bellotti L, Franco S, Toccafondi A, Miccinesi G, Rosselli M (2010) Assessment of psychological distress in cancer patients: a pivotal role of clinical interview. Psychooncology 19:1294–1302

    Article  CAS  PubMed  Google Scholar 

  4. Broers S, Hengeveld MW, Kaptein AA, Le Cessie S, van de Loo F, de Vries T (1998) Are pretransplant psychological variables related to survival after bone marrow transplantation? A prospective study of 123 consecutive patients. J Psychosom Res 45:341–351

    Article  CAS  PubMed  Google Scholar 

  5. Chang G, Orav EJ, Tong M, Antin JH (2004) Predictors of 1-year survival assessed at the time of bone marrow transplantation. Psychosomatics 45:378–385

    Article  PubMed  Google Scholar 

  6. Colón EA, Callies AL, Popkin MK, McGlave PB (1991) Depressed mood and other variables related to bone marrow transplantation survival in acute leukemia. Psychosomatics 32:420–425

    Article  PubMed  Google Scholar 

  7. Copelan EA (2006) Medical progress: haemopoietic stem cell transplantation. N Engl J Med 354:1813–1826

    Article  CAS  PubMed  Google Scholar 

  8. Cummins R (1995) On the trail of the gold standard for subjective well-being. Soc Indicators Res 35:179–200

    Article  Google Scholar 

  9. Derogatis LR (2000) Brief Symptom Inventory 18: administration, scoring, and procedures manual. National Computer Systems Inc, Minneapolis

    Google Scholar 

  10. Frick E, Motzke C, Fischer N, Busch R, Bumeder I (2005) Is perceived social support a predictor of survival for patients undergoing autologous peripheral blood stem cell transplantation? Psychooncology 14:759–770

    Article  CAS  PubMed  Google Scholar 

  11. Grassi L, Caruso R, Nanni MG (2013) Somatization and somatic symptom presentation in cancer: a neglected area. Int Rev Psychiatry 25:41–51

    Article  PubMed  Google Scholar 

  12. Gratwohl A (2012) The EBMT risk score. Bone Marrow Transplant 47:749–756

    Article  CAS  PubMed  Google Scholar 

  13. Grulke N, Bailer H, Caspari-Oberegelsbacher H, Heitz V, Juchems A, Tschuschke V, Kächele H (2004) Chapter 22 Patients confronted with a life-threatening situation: the importance of defense mechanisms in patients facing bone marrow transplantation. An empirical approach. In: Wolfram E (ed) Uwe Hentschel GSJGD. Advances in Psychology, North-Holland, pp 521–534

    Google Scholar 

  14. Grulke N, Bailer H, Hertenstein B, Kächele H, Arnold R, Tschuschke V, Heimpel H (2005) Coping and survival in patients with leukemia undergoing allogeneic bone marrow transplantation: long-term follow-up of a prospective study. J Psychosom Res 59:337–346

    Article  PubMed  Google Scholar 

  15. Grulke N, Bailer H, Larbig W, Kachele H (2006) Mental adjustment to cancer and survival of patients admitted for allogenic hemopoietic stem cell transplantation: a prospective cohort study. Psycho Soc Med 14:41–51

    Google Scholar 

  16. Grulke N, Larbig W, Kächele H, Bailer H (2008) Pre-transplant depression as risk factor for survival of patients undergoing allogeneic haematopoietic stem cell transplantation. Psychooncology 17:480–487

    Article  PubMed  Google Scholar 

  17. Hoodin F, Kalbfleisch KR, Thornton J, Ratanatharathorn V (2004) Psychosocial influences on 305 adults’ survival after bone marrow transplantation: depression, smoking, and behavioral self-regulation. J Psychosom Res 57:145–154

    Article  PubMed  Google Scholar 

  18. Hoodin F, Uberti JP, Lynch TJ, Steele P, Ratanatharathorn V (2006) Do negative or positive emotions differentially impact mortality after adult stem cell transplant? Bone Marrow Transplant 38:255–264

    Article  CAS  PubMed  Google Scholar 

  19. Johansson M, Ryden A, Finizia C (2011) Mental adjustment to cancer and its relation to anxiety, depression, HRQL and survival in patients with laryngeal cancer: a longitudinal study. BMC Cancer 11:283–291

    Article  PubMed Central  PubMed  Google Scholar 

  20. Loberiza FR, Rizzo JD, Bredeson CN, Antin JH, Horowitz MM, Weeks JC, Lee SJ (2002) Association of depressive syndrome and early deaths among patients after stem-cell transplantation for malignant diseases. J Clin Oncol 20:2118–2126

    Article  PubMed  Google Scholar 

  21. Molassiotis A, Van den Akker OBA, Milligan DW, Goldman JM (1997) Symptom distress, coping style and biological variables as predictors of survival after bone marrow transplantation. J Psychosom Res 42:275–285

    Article  CAS  PubMed  Google Scholar 

  22. Murphy KC, Jenkins PL, Whittaker J (1996) Psychosocial morbidity and survival in adult bone marrow transplant recipients: a follow-up study. Bone Marrow Transplant 18:199–201

    CAS  PubMed  Google Scholar 

  23. Osborne RH, Elsworth GR, Kissane DW, Burke SA, Hopper JL (1999) The Mental Adjustment to Cancer (MAC) Scale: replication and refinement in 632 breast cancer patients. Psychol Med 29:1335–1345

    Article  CAS  PubMed  Google Scholar 

  24. Park JE, Kin KI, Yoon SS, Hahm BJ, Lee SM, Jeong HY, Shin WG, Lee HS, Oh JM (2010) Psychological distress as a negative survival factor for patients with hematologic malignancies who underwent allogeneic hematopoietic stem cell transplantation. Pharmacotherapy 10:1239–1246

    Article  Google Scholar 

  25. Pillay B, Lee SJ, Katona L, Burney S, Avery S (2013) Psychosocial factors associated with quality of life in allogeneic stem cell transplant patients prior to transplant. Psychooncology. doi:10.1002/pon.3462

    PubMed  Google Scholar 

  26. Prieto JM, Atala J, Blanch J, Carreras E, Rovira M, Cirera E, Espinal A, Gasto C (2005) Role of depression as a predictor of mortality among cancer patients after stem cell transplantation. J Clin Oncol 23:6063–6071

    Article  PubMed  Google Scholar 

  27. Rodrigue JR, Boggs SR, Weiner RS, Behen JM (1993) Mood, coping style, and personality functioning among adult bone marrow transplant candidates. Psychosomatics 34:159–165

    Article  CAS  PubMed  Google Scholar 

  28. Rodrigue JR, Pearman TP, Moreb J (1999) Morbidity and mortality following bone marrow transplantation: predictive utility of pre-BMT affective functioning, compliance and social support stability. Int J Behav Med 6:241

    Article  CAS  PubMed  Google Scholar 

  29. Sherman AC, Simonton S, Latif U, Spohn R, Tricot G (2004) Psychosocial adjustment and quality of life among multiple myeloma patients undergoing evaluation for autologous stem cell transplantation. Bone Marrow Transplant 33:955–962

    Article  CAS  PubMed  Google Scholar 

  30. Tschuschke V, Hertenstein B, Arnold R, Bunjes D, Denzinger R, Kaechele H (2001) Associations between coping and survival time of adult leukemia patients receiving allogeneic bone marrow transplantation: results of a prospective study. J Psychosom Res 50:277–285

    Article  CAS  PubMed  Google Scholar 

  31. Uchino BN, Cacioppo JT, Kiecolt-Glaser JK (1996) The relationship between social support and physiological processes: a review with emphasis on underlying mechanisms and implications for health. Psychol Bull 119:488–531

    Article  CAS  PubMed  Google Scholar 

  32. Watson M, Greer S, Bliss JM (1989) Mental Adjustment to Cancer (MAC) Scale. User’s manual. CRC Psychological Medicine Research Group, Royal Marsden Hospital, Sutton

    Google Scholar 

  33. Watson M, Haviland JS, Greer S, Davidson J, Bliss JM (1999) Influence of psychological response on survival in breast cancer: a population-based cohort study. Lancet 354:331–336

    Article  Google Scholar 

  34. Watson M, Homewood J, Haviland JS, Bliss JM (2005) Influence of psychological response on survival in breast cancer: a population-based cohort study. Eur J Cancer 41:1710–1714

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest

The authors declare no conflicts of interest in relation to the work described. The authors have full control of all primary data, and the journal may review data if requested.

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Authors and Affiliations

  1. School of Psychological Sciences, Monash University, Bld 17, Clayton, VIC, 3168, Australia

    Brindha Pillay & Sue Burney

  2. Monash Alfred Psychiatry Research Centre, Alfred Health, Monash University, Melbourne, VIC, Australia

    Stuart J. Lee

  3. Department of Psychology and Consultation Liaison Psychiatry, Alfred Health, Melbourne, VIC, Australia

    Lynda Katona

  4. Cabrini Monash Psycho-oncology Unit, Cabrini Health, Malvern, VIC, Australia

    Sue Burney

  5. Malignant Haematology and Stem Cell Transplantation, Alfred Health, Melbourne, VIC, Australia

    Sharon Avery

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  1. Brindha Pillay
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  2. Stuart J. Lee
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  3. Lynda Katona
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  4. Sue Burney
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  5. Sharon Avery
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Correspondence to Brindha Pillay.

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Pillay, B., Lee, S.J., Katona, L. et al. Psychosocial factors predicting survival after allogeneic stem cell transplant. Support Care Cancer 22, 2547–2555 (2014). https://doi.org/10.1007/s00520-014-2239-7

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