Assessment of symptom burden in patients undergoing autologous stem cell transplantation

Abstract

Patients who undergo autologous peripheral blood stem cell (PBSC) transplantation experience multiple symptoms that affect quality of life. We assessed symptoms during the fi rst 30 days during and after autologous PBSC transplantation to determine the severity of individual symptoms and to determine overall symptom profi les in 120 patients with lymphoid malignancies that underwent autologous transplantation in our center. Eligible patients were at least 18 years of age, spoke maternal language, and could see and hear well enough to complete the assessment measures. The assessment of symptoms was measured according to the MD Anderson recommendations of 14 symptom profi ling, as well as correlated with the patient’s laboratory fi ndings, ECOG score and the profi le of mood states (POMS). We retrospectively evaluated if hematopoietic cell transplantation comorbidity index (HCT-CI), karnofsky performance status (PS) and other readily available pretransplant variables concerning pretransplant mobilization strategies that can also predict the outcome of autologous recipients in our transplant center. HCT-CI risk was low in 10 (12%), intermediate in 22 (27%) high in 45 (55%) and undetermined in 5 (6%). Two year OS was 45% (95%CI: 24-64%), 55% (95%CI: 40- 68%) and 42% (95%CI: 24-64%) in the low, intermediate and high-risk HCT-CI groups respectively. The repeated measures ANOVA for symptom severity scores (P<0.001) and symptom interference scores (P<0.001) showed only a main effect for time. None of the potential covariates (demographics, mood, quality of life, cancer diagnosis, treatment-related variables and laboratory measures) were signifi cant. Fatigue severity revealed a signifi cant time-by-cancer-diagnosis interaction (P=0.048), as well as pain severity (P=0.008). Sleep disturbance and lack of appetite revealed a signifi cant time interaction (P=0.02). The symptom patterns over time demonstrated by patients with non-Hodgkin’s lymphoma differed from those shown by patients with multiple myeloma. Future research can also identify differing clusters of symptoms in subgroups of patients who undergo stem cell transplantation.