Self-efficacy for symptom management in the acute phase of hematopoietic stem cell transplant: A pilot study.

PURPOSE: Hematopoietic stem cell transplant (HSCT) is an intensive treatment associated with distressing treatment and disease-related symptoms that affect patient outcomes such as functional status and quality of life. Self-efficacy for symptom management (SESM) is a person's belief in their ability to perform behaviors to prevent and relieve symptoms. Presence of SESM can impact symptom distress and functional status. This study describes the changes over time and relationships among SESM, symptom distress, and physical functional status in adults during the acute phase of HSCT. METHODS: Patients (n = 40) completed measures of symptom distress, SESM, and physical function at time points prior to and at days 7, 15 and 30 post-transplant. Clinical outcomes were length of stay and number of readmissions. RESULTS: Symptom distress, physical function, and SESM changed significantly over time. There was a significant negative relationship between symptom distress and physical function and between symptom distress and SESM at all points. The lowest levels of SESM and physical function were at day 7 when symptom distress was highest. Symptom distress was a moderator for the relationship between physical function and SESM at day 15. CONCLUSION: This was the first study to examine SESM in the acute phase of HSCT. Higher SESM was associated with fewer symptoms and increased physical function. Less symptom distress was associated with higher physical function and confidence to manage symptoms. These findings provide the basis for development of patient-centered interventions to enhance SESM when symptoms are at their highest immediately after HSCT.

[An impact of affective and cognitive impairment on the quality of life in patients with lymphoproliferative diseases]. / Vliianie affektivnykh i kognitivnykh narushenii na kachestvo zhizni u patsientov s limfoproliferativnymi zabolevaniiami.

AIM: To assess the neurological and cognitive status, identify the frequency of anxiety and depression in patients with lymphoproliferative diseases, and analyze their impact on the quality of life of patients. MATERIAL AND METHODS: Fifty-eight patients, including 35 (60.34%) men and 23 (39.66%) women aged from 42 to 86 years, with a diagnosis of chronic lymphocytic leukemia (CLL) or multiple myeloma (MM) were examined. Clinical and anamnestic methods, the Montreal scale of cognitive function assessment, the Hospital Anxiety and Depression Scale (HADS), the Functional Assessment of Cancer Therapy-General (FACT-G) were administered. RESULTS: Cognitive impairment was observed in 44 (75.86%) patients. Thirty-two (56.14%) patients had no symptoms of depression, clinically diagnosed depression was observed only in 8 (14.04%). In 37 (64.91%) patients, there were no symptoms of anxiety, clinically diagnosed anxiety was revealed in 6 (10.53%). The average score on the FACT-G scale for quality of life was 62.72±23.29 with a maximum score of 108. CONCLUSION: Cognitive impairment was observed in a large number of patients. Symptoms of depression were found in less than half of the patients, and manifestations of anxiety were found in one third. The presence of affective disorders, such as anxiety and depression, reduced quality of life evaluated in all its modules.

When a foreign adolescent orphan refuses to be treated: Considerations on a clinical case.

Providing medical treatment for unaccompanied foreign minors can prove particularly demanding when a patient is not fully compliant. This report describes the case of a 13-year-old boy from Sub-Saharan Africa brought to Italy to receive treatment for a neoplasm. Right from the start, he showed strong oppositional reactions, with aggressive and self-harming behavior. This made it necessary to activate various different psychological, psychiatric, and social-support resources, and to adapt the proposed treatments to the patient's willingness and ability to cooperate. Here we outline the assessments and actions (also from the economic and organizational standpoint) that need to be implemented in any scheme to bring young foreign orphans to Italy for specialist medical care.

Psychosocial factors associated with quality of life in allogeneic stem cell transplant patients prior to transplant.

OBJECTIVES: The primary aim of this retrospective study was to determine levels of psychological distress and quality of life (QoL) immediately prior to allogeneic stem cell transplantation. The secondary aim was to examine the demographic, medical and psychosocial factors that were correlated with various QoL domains at this stage of treatment. METHODS: A series of measures was completed by 122 allograft patients as part of routine psychological assessment at the treating hospital prior to undergoing the transplant. These included the Mental Adjustment to Cancer Scale, the Brief Symptom Inventory-18 and the World Health Organisation Quality of Life-BREF. Demographic and medical data were also extracted. RESULTS: In this study, 12% and 14% of the sample experienced significant levels of depressive and anxiety symptoms, respectively. Half of the sample reported impaired physical QoL, whereas approximately 40% reported poor psychological and social QoL. Besides relationship status, the limited number of demographic (age and gender) and medical factors (disease status) tested did not contribute significantly to reported QoL. After controlling for medical and demographic factors, weaker Fighting Spirit and higher levels of depression (trend towards significance) were associated with poorer physical and social QoL. CONCLUSIONS: The association among psychological distress, coping responses and QoL indicates that poor psychosocial functioning pre-transplant renders an increased likelihood of experiencing impaired QoL across various dimensions. It thus seems important that psychologically vulnerable patients are identified early in the treatment process. If psychosocial adjustment were improved, patients may experience better QoL pre-transplant with a potential subsequent influence on post-transplant outcomes.

A behavioral profile of autoimmune lupus-prone MRL mice.

Manifestations of the human autoimmune disease systemic lupus erythematosus (SLE) include a number of behavioral and cognitive deficits. The present study asks whether neurobehavioral dysfunction is present also in MRL mice that spontaneously develop most of the fundamental immunological aberrations of SLE. There are two congenic substrains of MRL mice that differ in the time of disease onset: MRL-lpr mice develop lupus early and MRL(-)+/+ develop the typical signs of disease relatively late in life. The behavior of these substrains was assessed at 7 to 11 weeks of age, a time that coincides with the onset of disease in MRL-lpr mice and the absence of known lupus symptoms in the MRL(-)+/+ group. When compared to the congenic MRL(-)+/+ control substrain, MRL-lpr mice were spontaneously less active, traversed a crossbeam slower, and ceased responding to the novelty of a new environment sooner. They were also more reluctant to leave their home base or travel far away from it and perseverated in their response bias during extinction and reversal learning. Immunological status was characterized by moderate proteinuria in both substrains and high titers of antinuclear antibodies in MRL-lpr but not MRL(-)+/+ mice. Histological analysis revealed minimal or no signs of joint pathology in MRL-lpr mice. Thus, this study shows the presence of behavioral dysfunction in mice with early stages of autoimmune disease and gives support for the idea that MRL mice may provide a useful model of neurobehavioral dysfunction in SLE. It is suggested that the behavioral profile of MRL-lpr mice may indicate increased "timidity," related to genetics, autoimmunity, or both.