Social and cultural variables: Ethnic differences in pain and other symptoms associated with blood or marrow transplantations

Abstract

BMT (Blood and marrow transplantation) is widely used and leads to a variety of severe symptoms. As with other cancer treatments, patients' survival and treatment effectiveness are linked with effective symptom management. Virtually no literature has examined African American or Hispanic experiences or symptoms with BMT, and little BMT research has been longitudinal. A recently completed study included the aim of evaluating the relationship of symptoms, functional status, and quality of life at multiple time points over the course of the BMT experience in these ethnic groups. The goals of this longitudinal study are to examine ethnic differences in pain and symptom report and to determine the relationships between symptoms, functional status and quality of life of patients during the first 100 days post-transplantation. Sixty-two patients (24 African-Americans and 38 Hispanics) completed the BMT module of the M.D. Anderson Symptom Inventory (MDASI) and the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT) at baseline and seven more times during the first 100 days post-transplantation. The patients' performance status was also recorded. There were no significant differences in symptom severity, symptom interference, quality of life and ECOG performance status between Hispanics and African-Americans over time. Pain was reported to be severe in 10 to 23% of patients over time. There were significant differences in symptom severity, symptom interference and ECOG performance status across time in both groups. These measures gradually increased starting from baseline, reached their maximum at T4 (when white blood cell counts were at nadir) and then started to decline. There were no significant differences in quality of life between ethnic groups. Changes in symptom interference are significantly correlated with changes in quality of life. Symptom interference for patients undergoing BMT was more closely related to quality of life than was symptom severity.