Impact of Psychological Distress on Quality of Life, Functional Status, and Survival in Patients with Chronic Graft-versus-Host Disease

Abstract

Data on psychological distress and its association with clinical outcomes in patients with chronic graft-versus-host-disease (GVHD) are lacking. We used data of patients with chronic GVHD (N = 482) from the Chronic GVHD Consortium, a prospective observational multicenter cohort. We examined the relationship between self-reported depression or anxiety symptoms (measured by the Lee Symptom Scale) and patients’ quality of life (QOL; measured by the Functional Assessment of Cancer Therapy-General [FACT-G] and the Physical Component Scale [PCS] of the 36-item Short-Form Health Survey), physical functioning (measured by the Human Activity Profile), functional status (measured by the 2-minute walk test), and overall survival (OS). Overall, 19.3% of patients (93/481) reported being moderately to extremely bothered by depression, and 22.8% (110/482) reported being moderately to extremely bothered by anxiety, with 14.1% (68/482) of those reporting being bothered by both. In multivariable models adjusted for clinical covariates, patients with self-reported depression had worse QOL (FACT-G: β = –23.09, P < .001; PCS: β = –4.94, P < .001), physical functioning (β = –8.31, P < .001), functional status (β = –37.21, P = .025), and lower OS (hazard ratio, 1.62; P = .020) compared with those with no depression symptoms. Patients who reported anxiety also had lower QOL (FACT-G: β = –19.47, P < .001; PCS: β = –3.91, P < .001), physical functioning (β = –6.69, P < .001), and functional status (β = –32.42, P = .036) but no difference in OS. Patients with chronic GVHD who report depression or anxiety symptoms have significantly compromised QOL and physical functioning. Self-reported depression is associated with lower OS. Patients with chronic GVHD and self-reported depression or anxiety represent a highly vulnerable population at risk for poor clinical outcomes and substantial morbidity from their illness.