The impact of psychosocial factors on psychological distress, quality of life, and survival of patients undergoing haematopoietic stem cell transplantation

Abstract

Haematopoietic stem cell transplantation (HSCT) is an invasive procedure that is used in the treatment of haematological cancers. Previous research has demonstrated that psychological distress and particular dispositional orientations may hamper the recovery process after treatment and lead to poorer quality of life (QoL) outcomes. However, there is limited research assessing the influence of such psychological factors in the early phase of HSCT. Thus, the overarching aims of the present research were to: determine the levels of psychological distress and QoL immediately prior to stem cell transplantation; examine the demographic, medical and psychosocial factors that were associated with various QoL domains prior to commencing treatment; assess the contribution of pre-transplant psychological factors to overall survival outcomes at a median follow-up of two years following HSCT; and to examine the impact of patient sense of coherence (SOC) on the levels of anxiety and depressive symptoms, and QoL dimensions in the acute phase post-transplantation. In Study 1, which used a correlational design, 147 allogeneic HSCT patients completed a series of measures as part of routine psychological assessment prior to transplantation. These measures included the Mental Adjustment to Cancer Scale, Brief Symptom Inventory – 18 (BSI-18), and World Health Organisation Quality of Life - BREF. Of the available sample, 122 completed all measures, and were included in the initial analysis. Twelve and 14% of this sample experienced significant levels of depressive and anxiety symptoms, respectively, prior to transplantation. At this time point, 49% of patients reported impaired physical QoL, while approximately 40% reported impaired psychological and social QoL. After controlling for medical and demographic factors, results of multiple regression analyses indicated that weaker fighting spirit and higher levels of depression were associated with poorer physical and social QoL. Survival status data were also obtained for the sample of 147 patients to ascertain whether pre-transplant psychological factors predicted survival following transplantation. Of the available sample, 130 patients completed all relevant measures, and were included in Cox-regression analyses. Results revealed that none of the pre-transplant psychological factors predicted post-HSCT survival. However, after accounting for post-transplant events such as acute graft-versus host disease and disease relapse, pre-transplant variables such as single relationship status and increased somatic symptoms were associated with shorter survival post-transplant. In Study 2, which adopted a longitudinal prospective design, 60 HSCT patients were administered the Orientation to Life Questionnaire (measure of SOC), Functional Assessment of Cancer Therapy - Bone Marrow Transplant and the BSI-18 prior to transplantation. Follow-up data were collected at 2-3 weeks and 3 months post-transplantation. Linear mixed-model analyses revealed that depression levels and physical and functional wellbeing were poorest at 2-3 weeks post-transplantation. SOC was positively associated with physical wellbeing prior to HSCT but not after transplantation. In addition, lower SOC predicted higher levels of depression and poorer social, emotional and functional wellbeing at both follow-up points, after accounting for physical wellbeing. Findings from the two studies support the need for psychosocial assessments of patients prior to undergoing HSCT to determine coping responses and dispositional orientations such as SOC. This would enable the identification of psychologically vulnerable patients early in the treatment process and allow for the provision of tailored psychological support prior to and following stem cell transplantation.