The association between physical functioning, symptom burden, and coping strategies with quality of life (QOL) in patients with chronic graft-versus-host disease (cGVHD).

Abstract

178 Background: Allogeneic stem cell transplant survivors with cGVHD experience substantial psychological distress and impairments in QOL. However, the relationship between patients’ physical functioning, symptom burden, coping strategies, and QOL over time is unknown. Methods: We conducted a longitudinal study of patients with moderate-severe cGVHD. We assessed patient-reported psychological distress (Hospital Anxiety and Depression Scale), QOL (Functional Assessment of Cancer Therapy-General), physical functioning (Human Activity Profile), cGVHD symptom burden (Lee Symptom Scale), and coping (Coping Inventory for Stressful Situations) at baseline, 3 months, and 6 months. Using mixed linear effects models, we examined the longitudinal relationship between QOL and physical functioning, cGVHD symptoms, and coping strategies. Results: We enrolled 53 patients with moderate (71.7%, 38/53) or severe (28.3%, 15/53) cGVHD. The rate of clinically significant depression and anxiety symptoms at baseline was 32.1% (17/53) and 30.2% (16/33), respectively, and did not change over time. Patients reported low QOL at baseline [M = 70.33, SD = 18.96], which did not change significantly over time [β = -0.66, SE = 1.11, P = 0.550]. Over time, higher physical functioning was associated with better QOL [β = 0.17, SE = 0.05, P = 0.001], while greater symptom burden was associated with worse QOL [β = -0.38, SE = 0.06, P < 0.001]. While the use of emotion-oriented coping was associated with lower QOL over time [β = -0.70, SE = 0.14, P < 0.001], the use of avoidance-oriented coping was associated with higher QOL over time [β = 0.38, SE = 0.10, P < 0.001]. Task-oriented coping was not associated with psychological distress or QOL. Conclusions: Patients with moderate-severe cGVHD report substantial psychological distress and persistently impaired QOL over time. Higher physical function and lower symptom burden are associated with improved QOL. The use of certain coping strategies was associated with changes in QOL. These data underscore the need for supportive care interventions to promote effective coping and enhance physical functioning in patients with cGVHD.