Cancer-and-treatment-specific distress and its impact on posttraumatic stress in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT).

Abstract

In this prospective multicenter study, we investigated cancer-and-treatment-specific distress (CTXD) and its impact on symptoms of posttraumatic stress disorder (PTSD) in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Patients were consulted before (T0, N=239), 3 (T1, N=150), and 12months (T2, N=102) after HSCT. Medical (eg, diagnosis and pretreatment) and demographic information, CTXD and PTSD (PCL-C) were assessed. Random intercept models revealed that the sum score of CTXD was highest pre-HSCT (T0), decreased by T1 (γ=-.18, 95% CI [-.26/-.09]), and by T2 (γ=-.10, 95% CI [-.20/-.00]). Uncertainty, family strain, and health burden were rated most distressing during HSCT. Uncertainty and family strain decreased from T0 to T1 (γ=-.30, 95% CI [-.42/-.17]; γ=-.10, 95% CI [-.20/-.00]) and health burden from T1 to T2 (γ=-.21, 95% CI [-.36/.05]). Women were more likely to report uncertainty (γ=.38, 95% CI [.19/.58]), family strain (γ=.38, 95% CI [.19/.58]), and concerns regarding appearance and sexuality (γ=.31, 95% CI [.14/.47]) than men. Uncertainty (γ=.18, 95% CI [.12/.24]), appearance and sexuality (γ=.09, 95% CI [.01/.16]), and health burden (γ=.21, 95% CI [.14/.27]) emerged as predictors of PTSD symptomatology across the 3 assessment points. Our data provide first evidence regarding the course of 6 dimensions of CTXD during HSCT and their impact on PTSD symptomatology. Specifically, results emphasize the major burden of uncertainty pre-HSCT and the impact of uncertainty and concerns regarding appearance and sexuality on PTSD symptomatology.