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Psychological and physical function in allogeneic hematopoietic cell transplant survivors with chronic graft-versus-host disease

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A Correction to this article was published on 23 August 2023

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Abstract

Purpose

Chronic graft-versus-host disease (cGVHD) is a common late complication of allogeneic hematopoietic cell transplantation (HCT). This study comprehensively evaluated physical and psychological function among individuals with cGVHD. Additional aims were to investigate relationships between disease severity and psychological and physical function, and to investigate patterns of psychological and physical function by disease site.

Method

Adults at least 6 months post allogeneic HCT were enrolled and either had cGVHD (n =59) or served as a reference sample of HCT survivors with no cGVHD history (n = 19). Participants completed self-report measures of depression, anxiety, fatigue, insomnia, pain, cognition, and sexual function and had a comprehensive clinical evaluation of cGVHD using NIH consensus scoring criteria. Participants with cGVHD were stratified by disease severity and site and compared to the reference group with no cGVHD.

Results

Participants with mild cGVHD had comparable psychological and physical symptoms to the reference sample, while participants with moderate cGVHD experienced more severe anxiety and problems with sexual function, and participants with severe cGVHD experienced more severe depressive symptoms and pain compared to the reference sample. Participants with cGVHD manifesting in the skin and GI tract had the most severe symptoms, including mood disturbance, fatigue, and pain.

Conclusions and Implications for Cancer Survivors

Results suggest that patients with more severe cGVHD and those with cGVHD manifesting in the skin, GI tract, and lungs are at risk for poorer psychological and physical outcomes and may benefit from proactive interventions to optimize function.

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Data availability

The dataset generated during and/or analyzed during the current study are not publicly available because, even after stripping the final dataset of identifiers, the possibility of deductive disclosure of participants remains given the relative rarity of the diagnoses, single study site, brief enrollment window, and small sample size. A combination of data from the medical record including diagnosis and treatment regimen, together with demographic data, could make it possible to identify individuals. Therefore, data are available from the corresponding author under a data-sharing agreement that provides for: (1) a commitment to using the data only for research purposes and not to identify any individual participant; (2) a commitment to securing the data using appropriate computer technology; and (3) a commitment to destroying or returning the data after analyses are completed.

Change history

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Acknowledgements

This is research was supported by the National Institutes of Health National Cancer Institute grant K07 CA 136966, the University of Wisconsin Carbone Cancer Center Support Grant P30 CA014520, the Clinical and Translational Science Award (CTSA) program through the National Institutes of National Center for Advancing Translational Sciences (NCATS), grant UL1 TR002373, and a University of Wisconsin Hilldale Award.

Funding

This is research was supported by the NIH National Cancer Institute grant K07 CA 136966, the University of Wisconsin Carbone Cancer Center Support Grant P30 CA014520, the Clinical and Translational Science Award (CTSA) program through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1 TR002373, and a University of Wisconsin Hilldale Award.

Author information

Authors and Affiliations

  1. Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, 6001 Research Park Blvd, Milwaukee, WI, 53719, USA

    Jenna L. Hansen, Mikayla A. Foster, Meredith E. Rumble & Erin S. Costanzo

  2. Masonic Cancer Center, University of Minnesota, 420 Delaware Street SE Minneapolis, Minneapolis, MN, 55455, USA

    Mark B. Juckett

  3. Center for Sleep Medicine and Research, University of Wisconsin-Madison, Madison, WI, USA

    Meredith E. Rumble

  4. Department of Psychiatry, Medical College of Wisconsin, 900 N 92nd St, Milwaukee, WI, 53226, USA

    Keayra E. Morris

  5. Division of Hematology, Medical Oncology, and Palliative Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, 1685 Highland Avenue, Madison, WI, 53705, USA

    Peiman Hematti

  6. University of Wisconsin Carbone Cancer Center, 1111 Highland Ave, Madison, WI, 53705, USA

    Peiman Hematti & Erin S. Costanzo

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Contributions

Jenna Hansen analyzed data, interpreted results, drafted manuscript, and revised manuscript. Mark Juckett conceived study, designed methodology, acquired funding, enrolled participants, performed clinical evaluations, interpreted results, and revised manuscript. Mikayla Foster interpreted the results and revised manuscript. Meredith Rumble designed methodology, interpreted results, and revised manuscript. Keayra Morris designed methodology, acquired data, and revised manuscript. Peiman Hematti conceived study, designed methodology, acquired funding, interpreted results, and revised manuscript. Erin Costanzo conceived study, designed methodology, acquired funding (PI), enrolled participants, supervised all data acquisition, analyzed data, interpreted results, drafted manuscript, and revised manuscript.

All authors approved the final version and agreed to be accountable for aspects of the work in ensuring that questions related to accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Erin S. Costanzo.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of the University of Wisconsin-Madison (9/29/14 / 2014-0752).

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that participants provided informed consent for publication of the anonymized data.

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The authors have no relevant financial or non-financial interests to disclose.

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Hansen, J.L., Juckett, M.B., Foster, M.A. et al. Psychological and physical function in allogeneic hematopoietic cell transplant survivors with chronic graft-versus-host disease. J Cancer Surviv 17, 646–656 (2023). https://doi.org/10.1007/s11764-023-01354-9

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