Does Desire to Pursue Pleasurable Activities Matter? The Impact of Pretransplantation Anhedonia on Quality of Life and Fatigue in Hematopoietic Stem Cell Transplantation.

Abstract

Anhedonia, the loss of the capacity to experience pleasure, is subjectively and biologically distinct from depressed mood. Few studies have specifically examined the association of pretransplantation anhedonia with key functional outcomes (eg, health-related quality of life [QOL]) in patients with hematologic malignancies who have undergone hematopoietic stem cell transplantation (HSCT). Among 248 HSCT recipients enrolled in 2 intervention trials, we examined the associations between pretransplantation anhedonia and both QOL and fatigue at 2 weeks and 6 months post-transplantation. Across time points, patients completed the Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Therapy-Bone Marrow Transplant, and Functional Assessment of Cancer Therapy-Fatigue subscale, which we used to measure depressive symptoms, QOL and fatigue, respectively. Pretransplantation anhedonia was assessed using the corresponding item in the Patient Health Questionnaire-9. The Functional Assessment of Cancer Therapy-Bone Marrow Transplant and the Functional Assessment of Cancer Therapy-Fatigue subscales were used to measure QOL and fatigue. Associations between pretransplantation anhedonia and outcomes were assessed using regression analyses, adjusting for age, sex, transplant type, and intervention group. Ninety-eight patients (39.5%) reported pretransplantation anhedonia, of whom 60 (61%) did not meet the criteria for elevated depressive symptoms. Pretransplantation anhedonia was negatively associated with QOL at 2 weeks (B=-17.21; 95% confidence interval [CI], -23.05 to -11.30; P < .001) and at 6 months (B=-15.10; 95% CI, -21.51 to -8.69; P< .001). Pretransplantation anhedonia was also negatively associated with fatigue (2 weeks: B=-9.35; 95% CI, -12.47 to -6.22; P< .001; 6 months: B=-5.68; 95% CI, -9.07 to -2.28; P= .001). The association between pretransplantation anhedonia and QOL and fatigue remained significant after adjusting for depression scores. Pretransplantation anhedonia is negatively and significantly associated with QOL and fatigue in HSCT recipients. These findings underscore the need to incorporate anhedonia assessment in the evaluation and management of psychological distress in these patients.