Risk factors for depression and fatigue among survivors of hematopoietic cell transplantation

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Abstract

Patients treated with hematopoietic cell transplant (HCT) often experience depression and fatigue but analyses to determine risk factors have typically lacked statistical power. This study examined sociodemographic and clinical risk factors for depression and fatigue in a large cohort of HCT survivors. Measures of depression and fatigue were included in an annual survey of HCT recipients which also included self-reported sociodemographic and health information. Patient clinical characteristics were obtained from the clinical database. The sample consisted of 1869 recipients (mean age 56, 53% male) who were a mean of 13 years (allogeneic recipients) and 6 years (autologous patients) since HCT. Moderate to severe depression was reported by 13% of participants; moderate to severe fatigue was reported by 42%. Among allogeneic recipients, female gender, younger age, current presence of chronic pain, and current patient-reported severity of chronic graft-versus-host disease (GVHD) were independently associated with greater depression whereas female gender, current presence of chronic pain, and current severity of chronic GVHD were independently associated with greater fatigue (p values<.01). Among autologous recipients, younger age and current presence of chronic pain were independently associated with both greater depression and greater fatigue (p values<.01). Rates of depression and fatigue in this group of survivors suggest a high symptom burden. Better screening, referral, and interventions are needed. This study examined sociodemographic and clinical risk factors for depression and fatigue in a large cohort of hematopoietic cell transplant survivors. Several risk factors were independently associated with depression and fatigue, including gender, age, current severity of chronic graft-versus-host disease, and current presence of chronic pain.

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Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age.

Wolfgang Linden, Andrea Vodermaier, Regina MacKenzie … (2012)

Reported prevalence of emotional distress in cancer patients varies widely across studies. The present study determined prevalence of anxiety and depression (separated for presence of symptoms versus clinical levels) in a large, representative sample of cancer patients after diagnosis. During the years 2004-2009, 10,153 consecutive patients were routinely screened with the Psychosocial Screen for Cancer questionnaire at two major cancer centers. Patients' mean age was 59 years and 45% were men. Across cancer types, 19.0% of patients showed clinical levels of anxiety and another 22.6% had subclinical symptoms. Further, 12.9% of patients reported clinical symptoms of depression and an additional 16.5% described subclinical symptoms. Analyses by cancer type revealed significant differences such that patients with lung, gynecological, or hematological cancer reported the highest levels of distress at the time point of cancer diagnosis. As expected, women showed higher rates of anxiety and depression, and for some cancer types the prevalence was two to three times higher than that seen for men. In some cancer types emotional distress was inversely related to age. Patients younger than 50 and women across all cancer types revealed either subclinical or clinical levels of anxiety in over 50% of cases. Findings describe levels of emotional distress after diagnosis but cannot inform about trajectories of anxiety and depression over time. Given that levels of anxiety and depression varied widely by cancer type, gender, and age, these results inform which cancer patients are most likely in need of psychosocial support. Copyright © 2012 Elsevier B.V. All rights reserved.

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The symptom cluster of fatigue, pain, anxiety, and depression and the effect on the quality of life of women receiving treatment for breast cancer: a multicenter study.

E. Marsh, Ronald W K So, Yuet-Kin Leung … (2009)

To examine the symptom cluster of fatigue, pain, anxiety, and depression and its effect on the quality of life (QOL) of women receiving chemotherapy or radiotherapy for breast cancer. Descriptive. Oncology outpatient sections of four public hospitals in Hong Kong. 215 ethnic Chinese women who were midway through treatment for breast cancer. Chinese versions of the Brief Fatigue Inventory, Hospital Anxiety and Depression Scale, Brief Pain Inventory, Functional Assessment of Chronic Illness Therapy for Breast Cancer, and Medical Outcomes Study Social Support Survey were used. Spearman rho correlation and structural equation modeling were used to examine the relationships among the study variables. Breast cancer, fatigue, pain, anxiety, depression, and QOL. Most participants reported mild-to-moderate levels of fatigue and pain. Twenty-one percent and 36% of patients might have had an anxiety or depression disorder, respectively. Significant correlations among the four symptoms supported the existence of the symptom cluster. The participants receiving chemotherapy had inadequate social support, experienced higher levels of symptoms, and were more likely to have a poorer QOL. The findings supported the existence of the symptom cluster that had detrimental effects on QOL. This study shed light on a contemporary approach of grouping several related symptoms together. The findings enhance nurses' clinical sensitivity when identifying patients in high-risk groups and provide useful information for designing and prioritizing symptom-management strategies to meet patients' needs.

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Quality of life and mood of patients and family caregivers during hospitalization for hematopoietic stem cell transplantation.

Areej El-Jawahri, Lara N Traeger, Kailyn Kuzmuk … (2015)

We conducted a study to investigate the impact of hospitalization for hematopoietic stem cell transplantation (HCT) on the quality of life (QOL) and mood of patients and family caregivers (FC).