When patients undergo hematopoietic cell transplantation (HCT), they are usually hospitalized and isolated for a prolonged period and may experience a substantial physical and psychological symptom burden. To gather insight into the incidence of post-traumatic stress disorder (PTSD) and its risk factors in this population, Sarah Griffith, BA, and colleagues prospectively analyzed 250 patients who underwent autologous and allogenic HCT at Massachusetts General Hospital between August 2014 and January 2016. The results were presented as part of the ASCO20 Virtual Scientific Program.
“Identifying factors associated with severity of PTSD symptoms would be helpful to tailor interventions to vulnerable or higher-risk populations,” Ms. Griffith said.
Eligible patients were at least 18 years of age, had been diagnosed with a hematologic malignancy, and were able to respond to questionnaires in English with minimal assistance. Patients with non-neoplastic hematologic conditions or with active psychiatric conditions that could interfere with symptom assessment were excluded.
PTSD symptoms were identified using the PTSD Checklist (PTSD-CL), and the study authors used the Functional Assessment of Cancer Therapy – Bone Marrow Transplant and the Hospital Anxiety and Depression Scale to assess quality of life (QoL), depression, and anxiety symptoms. PTSD symptoms were assessed at one time point, 6 months post-HCT. QoL, depression, and anxiety symptoms were assessed at the time of admission for HCT, week 2 of hospitalization, and 6 months post-transplant.
The mean age of patients in the study was 56.3 years. Of the 250 patients, 48.8% (n=122) were male and 51.2% (n=128) were female. The majority (88%) were white. Eighty-one patients (32.4%) were diagnosed with acute leukemia, 71 (28.4%) with lymphoma, 50 (20%) with myeloma, and 48 (19.2%) with another hematologic malignancy such as myelodysplastic syndromes or a myeloproliferative neoplasm. Nearly one-half (44%; n=110) were undergoing autologous HCT, while 19.2% (n=48) were undergoing myeloablative allogeneic HCT, and 36.8% (n=92) were undergoing reduced intensity conditioning allogeneic HCT.
Of the patients enrolled in the study, 18.9% experienced PTSD symptoms, the most common of which were avoidance and hypervigilance. Patients who were married or had a long-term partner were less likely to experience PTSD symptoms, while those who had anxiety or depression symptoms at baseline or an increase in anxiety during the HCT process were more likely to develop PTSD symptoms.
“Intervention during HCT could be beneficial in preventing PTSD symptoms,” Ms. Griffith concluded. “For example, we know from other work of our research group that integrating palliative care during the transplant hospitalization can reduce the risk of PTSD at 6 months post-transplant.”
Limitations of this study include its homogenous patient population from a single tertiary hospital and inability to assess the causality of the relationship between baseline factors and PTSD symptoms.
The authors report no relevant conflicts of interest.
Griffith S, Fenech AL, Nelson A. Post-traumatic stress symptoms in hematopoietic stem cell transplant (HCT) recipients. J Clin Oncol. 38: 2020 (suppl; abstr 7505). Presented as part of the ASCO20 Virtual Scientific Program. May 29-31, 2020.