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Relationships among symptoms, psychosocial factors, and health-related quality of life in hematopoietic stem cell transplant survivors

Abstract

Purpose

The study aims to evaluate the mediating effect of depressive symptoms on the relationship between physical symptoms and health-related quality of life (HRQOL) in hematopoietic stem cell transplant (HSCT) survivors and to test a conceptual model of psychosocial factors, in addition to physical and psychological symptoms, that might contribute to HRQOL.

Methods

This is a secondary data analysis using HSCT survivors (N = 662) identified from the Center for International Blood and Marrow Transplant Research. Data were collected through mail and phone surveys and medical records. We used structural equation modeling to test the mediating role of depressive symptoms on the relationship of physical symptoms with HRQOL. We also tested comprehensive pathways from physical symptoms to HRQOL by adding psychosocial factors (optimism, coping, and social constraints).

Results

In the depressive symptom mediation analyses, physical symptoms had a stronger direct effect on physical HRQOL (b = −0.98, p < 0.001) than depressive symptoms (b = 0.23, p > 0.05). Depressive symptoms were associated with mental HRQOL and mediated the relationship between physical symptoms and mental HRQOL. In comprehensive pathways, physical symptoms remained the most significant factor associated with physical HRQOL. In contrast, depressive symptoms had direct effects (b = −0.76, p < 0.001) on mental HRQOL and were a significant mediator. Psychosocial factors were directly associated with mental HRQOL and indirectly associated with mental HRQOL through depressive symptoms.

Conclusion

Physical symptoms are most strongly associated with physical HRQOL, while depressive symptoms and psychosocial factors impact mental HRQOL more than physical HRQOL. Interventions addressing psychosocial factors as well as symptoms may improve the HRQOL of HSCT survivors.

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Abbreviations

HSCT:

Hematopoietic stem cell transplant

HRQOL:

Health-related quality of life

PCS:

Physical component summary

MCS:

Mental component summary

CFI:

Confirmatory fit index

RMSEA:

Root mean square error of approximation

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Acknowledgements

This work was partially supported by the National Cancer Institute NCI R01 CA81320 07/1999-07/2003 (PI: Dr. John Wingard)

Conflict of interest

Dr. Kelly Kenzik, Dr. I-Chan Huang, Dr. Douglas Rizzo, Dr. Elizabeth Shenkman, and Dr. John Wingard declare that they have no conflicts of interest. The authors have full control of all primary data and agree to allow the journal to review their data if requested

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Correspondence to Kelly Kenzik.

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Kenzik, K., Huang, IC., Rizzo, J.D. et al. Relationships among symptoms, psychosocial factors, and health-related quality of life in hematopoietic stem cell transplant survivors. Support Care Cancer 23, 797–807 (2015). https://doi.org/10.1007/s00520-014-2420-z

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Keywords

  • Hematopoietic stem cell transplant
  • Cancer survivor
  • Symptoms
  • Psychosocial factors
  • Health-related quality of life