Quality of Life Scores Pre and Post Autologous Stem Cell Transplant: A Comparison of Patients Greater Than 60-Years-Old Vs Younger Than 60-Years-Old

Abstract

Prospective quality of life instruments were administered to 304 patients with non-Hodgkin's lymphoma (NHL), Hodgkin disease (HD), and Multiple Myeloma (MM) undergoing autologous stem cell transplantation (ASCT) from June 2003 through December 2007. The two groups were fairly balanced with respect to baseline characteristics with the younger group having slightly more HD and the older group having slightly more NHL. Of the 304 total patients, 65% had NHL, 21% MM, and 14% HD; median age was 53; 60% were male; 25% received prior radiation therapy; preparative regimens were busulfan based or melphalan; all patients received peripheral stem cells alone, median inpatient length of stay was 21 days. The Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) and the Profile of Mood State (POMS) were administered to patients prior to their priming for stem cell collection and again 40–44 days (Day 42) post ASCT. The FACT-BMT measures five components: physical well being (PWB), social well being (SWB), emotional well being (EWB), functional well being (FWB), and additional concerns (AC). The POMS measures depression, vigor, anger, tension, confusion, and fatigue. In looking at the FACT-BMT the 60 + group reported better emotional well-being at baseline than the <60 group (p= 0.008) and on day 42 post transplant the 60+ group reported significantly better EWB from the under 60 group (p<0.001). Both groups report a decrease in FWB from baseline to day 42 (p=0.022) but the 60+ group reports higher FWB than the other group. Results of the POMS indicates that the <60 group reported higher depression and anger at baseline than did the 60+ group (p<0.001). The <60 group also reported greater tension (p=0.002) at baseline. Confusion was rated slightly higher at baseline also by the <60 group (p=0.020). There were no significant differences between the two groups in these areas at day 42. In conclusion, one can speculate that the 60+ group is more likely to have experienced family or personal crisis prior to their diagnosis and may have more established coping mechanisms on which to rely. Additionally, those in the <60 group may tend to have more family and employment considerations that may distract them from being able to focus on their treatment and preparation for transplant. It is possible that the <60 group would benefit from earlier involvement from the social worker to assess their needs and more specialized family oriented education and/or materials.