Long-term parental distress after pediatric hematopoietic stem cell transplantation for nonmalignant diseases.

Abstract

Survival rates have continued to increase for pediatric hematopoietic stem cell transplantation (HSCT) for nonmalignant diseases. Despite the crucial role of caregivers in this high-intensity treatment, knowledge about long-term parental impact is lacking. This cross-sectional study assessed parental distress and everyday problems in parents of patients 2years and older after pediatric HSCT for a nonmalignant disease using Distress Thermometer for Parents (DT-P), and compared outcomes to matched Dutch parents of healthy children and Dutch parents of children with a chronic condition (CC). Median follow-up was 5.3years (interquartile range [IQR]: 2.9-8.6). Underlying diseases were inborn errors of immunity (N=30), hemoglobinopathies (N=13), and bone marrow failure (N=27). Mothers of pediatric HSCT recipients (N=70) reported comparable overall distress levels to mothers of healthy children, but experienced more distress related to parenting problems, specifically managing their child's emotions, discussing disease consequences, and fostering independence. Fathers of HSCT recipients (N=45) reported higher overall distress levels and had more emotional distress compared to fathers of healthy children. Overall, parental distress and everyday problems of parents of HSCT recipients are comparable to those of parents of children with CC. However, there is ongoing parental burden, both emotional and in parenting, long-term after HSCT compared to parents of healthy children, and the type of burden differs between mothers and fathers. These results indicate that individualized parental supportive care should not remain restricted to the acute hospitalization phase, but also be actively offered during long-term follow-up after pediatric HSCT.