Abstract
Hematopoietic stem cell transplantation (HSCT) requires an intensive pre- and post-procedure course that leads to symptoms including fatigue, nausea/vomiting, and pain, all of which interfere significantly with activities of daily living. These symptoms place a substantial burden on patients during the time period surrounding transplant as well as during long-term recovery. The MD Anderson Symptom Inventory (MDASI) is a symptom-reporting survey that has been successfully used in adult patients with cancer and may have utility in the adolescent and young adult (AYA) population. At the Children’s Cancer Hospital at MD Anderson Cancer Center, we adopted a modified version of the MDASI, the MDASI-adolescent (MDASI-Adol), as a standard of care for clinical practice in assessing the symptom burden of patients in the peri-transplant period. We then conducted a retrospective chart review to describe the clinical utility of implementing this symptom-screening tool in AYA patients admitted to our pediatric stem cell transplant service. Here, we report our findings on the symptom burden experienced by pediatric and AYA patients undergoing stem cell transplantation as reported on the MDASI-Adol. Our study confirmed that the MDASI-Adol was able to identify a high symptom burden related to HSCT in the AYA population and that it can be used to guide symptom-specific interventions prior to transplant and during recovery. Implementing a standard symptom-screening survey proved informative to our clinical practice and could mitigate treatment complications and alleviate symptom burden.
Highlights
Hematopoietic stem cell transplantation (HSCT) in the pediatric and adolescent population requires an intense pre- and post-transplant treatment regimen
Using the day of stem cell transplantation as day 0, we calculated the average days before and after transplantation that an MD Anderson Symptom Inventory (MDASI)-Adol was completed by a patient in both phases and we evaluated the number of surveys completed per patient, the number of symptoms reported per patient, and the number of interventions/consultations per patient in the two phases of MDASI-Adol administration
Of the 24 patients, 17 completed the MDASI-Adol in the first phase, prior to standardization of MDASI-Adol administration; 4 completed the MDASI-Adol in the second phase in which the MDASI-Adol was administered in a standard fashion; 2 patients declined to complete the MDASI-Adol at any point during their hospitalization; 1 patient was unable to complete the MDASI-Adol due to persistent altered mental status (AMS)
Summary
Hematopoietic stem cell transplantation (HSCT) in the pediatric and adolescent population requires an intense pre- and post-transplant treatment regimen. In the period surrounding HSCT, patients often have symptoms such as painful mucositis, infection, fatigue, nausea/vomiting, decreased appetite, and psychological stress [2,3]. This symptom burden can lead to significant distress and reduce patients’ quality of life [1]. Common barriers to symptom control in patients receiving cancer-directed therapy include miscommunication between providers and patients, delays in interventions, and lack of age-appropriate patient-reported outcomes (PROs) [5]. Measurement tools that allow patients to report symptoms during or following cancer-directed care/HSCT may lead to earlier interventions to mitigate symptom severity [7]. Symptom mitigation has been shown to lessen the distress that patients experience during treatment and improves their quality of life [8]
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