Health-Related Quality of Life (HRQL) in Adult Long-Term Hematopoietic Cell Transplant (HCT) Survivors: A Report from the Bone Marrow Transplant Survivor Study.

Abstract

We describe HRQL reported by adult survivors of autologous and allogeneic HCT and the risk factors associated with poor HRQL. Eligible subjects were individuals undergoing HCT at either City of Hope or the University of Minnesota between 1974 and 1998, and surviving two or more years after HCT. We analyzed the data from 1003 HCT survivors older than 21 years enrolled in a retrospective cohort study who had completed a validated City of Hope HCT-QOL tool. Of these, 54.5% were males, 80.2% were Caucasians, and 55% had received allogeneic HCT. The primary diagnoses included CML (n=233), AML (n=241), NHL (n=200), ALL (n=99), HD (n=88), and other (n=142). The median age at HCT was 35.4, median age at study participation: 43.4 years, and the median length of follow-up: 9.4 (2 to 28 years). Survivors' responses were compared with those of the population norms in Physical, Psychological, Social and Spiritual domains, and overall quality of life (QOL). Poor QOL was defined as QOL scores less than two standard deviations below that reported for the tool norms. Using this definition, 9.2% of this cohort was identified to have poor overall QOL; 13.7% with poor Physical; 10% with poor Psychological; 6.7% with poor Social; and 4.3% with poor Spiritual well-being. Table below shows the results of the risk factors identified for poor QOL by multivariate analysis. Age, sex, type of HCT, and time since HCT were not associated with poor QOL. Thus, overall 9% of the long-term HCT survivors report poor overall QOL. Certain vulnerable sub-populations exist, specifically, low household income, difficulty in obtaining health insurance, inability to return to work, and the presence of pain and anxiety that impact upon the HRQL of this population, and require additional attention and possible intervention.Predictors of PoorRisk Factors for Poor QOLOverall QOLPhysicalPsychologicalSocialSpiritualRelative Risk (p-value)Relative Risk (p-value)Relative Risk (p-value)Relative Risk (p-value)Relative Risk (p-value)Non-white race2.1 (0.06)2.4 (0.005)1.6 (0.1)2.0 (0.06)0.5 (0.2)Inability to return to work3.4 (0.003)4.9 (<0.001)3.6 (<0.001)3.6 (0.002)0.8 (0.7)Inability to return to school2.4 (0.2)4.6 (0.005)5.2 (0.002)1.1 (0.8)0.9 (0.9)Difficulty in obtaining health insurance1.7 (0.1)1.9 (0.04)0.9 (0.9)3.6 (<0.001)2.2 (0.05)Absence of health insurance2.6 (0.05)1.3 (0.6)0.7 (0.5)1.6 (0.4)4.2 (0.005)Household income <$20k3.0 (0.04)0.9 (0.9)4.4 (0.006)2.2 (0.1)3.1 (0.05)CGVHD2.1 (0.02)1.8 (0.02)1.9 (0.04)1.4 (0.3)1.5 (0.3)Severe pain8.8 (<0.001)12.6 (<0.001)2.4 (0.07)5.4 (0.001)2.8 (0.07)Severe anxiety240.2 (<0.001)5.3 (0.001)60.2 (<0.001)7.8 (<0.001)19.7 (<0.001)