Fluctuation in physical symptoms, coping, and mood in patients following hematopoietic stem cell transplantation: assessing mediation effects using a daily diary approach.

This study examines the indirect effect between parallel fluctuation in daily physical symptoms, symptom-related coping, and mood in patients following hematopoietic stem cell transplantation. Two models were analyzed with a within-person mediating role of coping and mood, respectively. Physical symptoms, coping (brooding, reflection, co-rumination, positive reframing, venting, acceptance, and active coping), and positive (PA) and negative affect (NA) were reported by 229 patients for 28 consecutive evenings after post-transplant hospital discharge. The mediating role of coping fluctuation was partially supported since a competitive model assuming coping reactivity was more reliable. Fluctuation in daily PA and NA mediated relationship of physical symptoms with brooding, co-rumination and venting. Daily changes in positive reframing, acceptance and reflection, partially mediated the association between changes in physical symptoms and mood. The study results indicate the usefulness of intervention addressed to the management of daily mood and stimulation of positive reframing and acceptance in post-HSCT patients.

Everyday life following hematopoietic stem cell transplantation: decline in physical symptoms within the first month and change-related predictors.

PURPOSE: Lower quality of life, especially in the physical domain (Physical-QOL), is common in patients after hematopoietic stem cell transplantation (HSCT). However, few studies explore changes in the Physical-QOL, i.e., physical symptoms, in everyday life of patients following HSCT. The present study addresses this gap by examining patient daily physical symptoms and their predictors in terms of demographic and clinical characteristics. METHODS: Physical symptoms were reported by 188 patients (56.9% men; aged 47.6 ± 13.4 years) for 28 consecutive days after post-HSCT hospital discharge. Multilevel modeling was used to investigate fixed and random effects for physical symptom changes over time. RESULTS: The results indicated that the initial level of physical symptoms (immediately after hospital discharge) systematically decreased over 28 days. Treatment toxicity (WHO scale; ß = 0.09, p < .01) and baseline depressive symptoms (CES-D scale; ß = 0.06, p < .01) were associated with the initial level of physical symptoms. Patients with more depressive symptoms before HSCT and with more adverse treatment effects presented with more physical symptoms immediately after hospital discharge. The type of transplant, diagnosis, and conditioning regimen differentiated the course of physical symptoms. Patients with leukemias and other myeloid neoplasms (ß = 0.05, p < .01), after allogeneic HSCT (ß = -0.06, p < .01), and with non-myeloablative conditioning (ß = -0.09, p < .01) showed a significant lower decrease in symptoms over time. Patients with multiple myeloma presented with the most rapid improvement (ß = -.03, p < .05). CONCLUSIONS: The findings suggest a heterogeneous and rather positive response to HSCT. Treatment-related conditions occurred to be a significant predictor of the intensity of change in physical functioning after HSCT.

Psychophysical well-being profiles in patients before hematopoietic stem cell transplantation.

OBJECTIVES: The literature offers very few in-depth reports on the time directly before hematopoietic stem cell transplantation (HSCT). Also, researchers have focused on selected aspects of psychophysical well-being and treated the sample as homogeneous. Thus, we chose to investigate distinct multidimensional well-being profiles (including anxiety, depressive symptoms, and health-related quality of life [HRQOL] domains) among patients just before HSCT, as well as profile predictors (generalized self-efficacy) and outcomes (transplant appraisal) on the basis of the transactional stress model. METHODS: Depression (CES-D), anxiety (HADS-A), HRQOL (EORTC QOL-C30), generalized self-efficacy (GSES), and transplant appraisal (single-item scale referred to threat and challenge) were measured in 290 patients (56.9% male; mean age = 47.28, SD = 13.79) after admission for HSCT (67.2% autologous). Unconditional and conditional latent profile analyses were applied. RESULTS: Four latent well-being profiles were identified: well-functioning (51%, highest well-being in all aspects), dysfunctional (10%, weakest functioning in all aspects), and 2 profiles with moderate HRQOL and high (5.6%) or low (33.4%) anxiety and depressive symptoms. Generalized self-efficacy predicted profile membership, controlling for demographic and clinical variables. The highest levels were observed in the well-functioning group (P < .01). Appraisal was predicted by latent profile analyses classes: low threat in the well-functioning group (P < .001) and the highest threat and challenge in the dysfunctional group (P < .01). CONCLUSIONS: The findings highlight the diverse nature of well-being in pre-HSCT patients and the manner in which transplant appraisal and generalized self-efficacy are related to different profiles of pre-HSCT multidimensional well-being, thus indicating the practical implications of the study.