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1.
Psychooncology ; 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32040229

RESUMO

OBJECTIVE: Cancer-associated cognitive decline is a concern among cancer survivors. Survivors' memory lapses (eg, location of keys, names, reason entered room) may negatively impact quality of life. This study used smartphone-based surveys to compare cancer survivors to those without cancer history on frequency of, severity of, and affective response to daily memory lapses. METHODS: For 14 evenings, breast cancer survivors (N = 47, M age = 52.9) and women without a cancer history (N = 105, M age = 51.8) completed smartphone-based surveys on memory lapse occurrence and severity and negative and positive affect. RESULTS: Survivors were nearly 3 times more likely to report a daily memory lapse but did not differ from comparison group on memory lapse severity. Negative affect was significantly higher on days with memory lapses associated with doing something in the future (eg, appointments) but this did not differ across groups. Positive affect was not significantly related to survivorship status or the occurrence of daily memory lapses. CONCLUSION: Survivors may be at-risk for more frequent memory lapses. Both survivors and women without a history of cancer reported greater negative affect on days when memory lapses occurred, suggesting that daily cognitive functioning may have important implications for quality of life. This article is protected by copyright. All rights reserved.

2.
Support Care Cancer ; 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31916007

RESUMO

PURPOSE: Cancer has long-term financial consequences. Adolescent and young adult (AYA) and middle-aged cancer survivors may experience more financial toxicity than older adults. This study examined age differences in financial distress in hematopoietic cell transplant survivors and whether these differences result from measurement bias, more financial barriers to care, or an overall higher level of distress. METHODS: Hematologic malignancy survivors (n = 1135, 2-10 years post-transplant) completed the Cancer and Treatment Distress Scale (CTXD) and demographics as part of the baseline assessment for a randomized clinical trial. The CTXD has seven subscales, but for this study, we examined the financial distress subscale and the overall score. Item response theory analyses tested for bias by age and gender. Multivariate linear regression tested the association of age and gender with the CTXD scores while controlling for financial barriers to care. RESULTS: No bias was found on the CTXD. AYA (p < 0.01) and middle-aged adults (p < 0.001) reported more financial and overall distress than older (age 65+) adults. The same association of age and financial distress was observed in women (p < 0.01). However, only middle-aged men (p < 0.01) reported more financial and overall distress than older men; AYA men did not (p > 0.18). Financial barriers to care were not associated with financial or overall distress. CONCLUSIONS: Part of the increase in financial distress with younger age may be due to a higher risk of general distress. Policy initiatives to control cancer costs should consider life stage and the unique financial challenges at different ages for men and women.

3.
J Geriatr Oncol ; 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31917114

RESUMO

OBJECTIVE: Recent advances in health monitoring technology have coincided with increases in the number of older adults with cancer, many of whom report difficulty using health information technology (HIT). Previous studies have identified lower electronic health (eHealth) literacy among older adults (≥65 years) compared to younger adults (<65), but studies in older adults with cancer are limited. The goal of this study was to examine age differences in eHealth literacy and use of technology devices/HIT in patients with cancer, and characterize receptivity towards using home-based HIT to communicate with the oncology care team. MATERIALS AND METHODS: Patients (n = 198) in a Radiation Oncology clinic were offered an anonymous written questionnaire assessing demographics, eHealth literacy (eHealth Literacy Scale), current use of HIT, and interest in using home-based HIT. RESULTS AND CONCLUSION: Compared to younger patients, older patients had significantly lower eHealth literacy (p < .01), and were less likely to feel confident evaluating health resources on the Internet (p < .01) or knowing how to use the health information found on the Internet to help them (p < .01) or answer health questions (p = .01). Older patients were also less likely than younger patients to have an email address (p = .04), own a smartphone (p < .01), or use the online patient portal (p = .03). Regardless of age, most patients were not opposed to using home-based HIT to communicate with their oncology care team. Future studies on HIT use in older adults with cancer should further evaluate barriers to using HIT and ways to maximize implementation and accessibility.

4.
Cancer ; 126(1): 174-180, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31553815

RESUMO

BACKGROUND: Fatigue is a common and disabling side effect of targeted therapies such as tyrosine kinase inhibitors (TKIs) used to treat chronic myeloid leukemia (CML). The goal of the current study was to conduct a pilot randomized trial of the first cognitive behavioral intervention developed for fatigue due to targeted therapy. METHODS: Patients with CML treated with a TKI who were reporting moderate to severe fatigue were recruited and randomized 2:1 to cognitive behavioral therapy for targeted therapy-related fatigue (CBT-TTF) delivered via FaceTime for the iPad or to a waitlist control (WLC) group. The outcomes were acceptability, feasibility, and preliminary efficacy for fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue; primary outcome) and quality of life (Functional Assessment of Cancer Therapy-General; secondary outcome). Participants were assessed before randomization and after treatment (ie, approximately 18 weeks later). RESULTS: A total of 44 patients (mean age, 55 years; 48% female) were assigned to CBT-TTF (n = 29) or WLC (n = 15). The study participation rate was 59%. Among the patients assigned to CBT-TTF, 79% completed the intervention. Intent-to-treat analyses indicated that patients assigned to CBT-TTF demonstrated greater improvements in fatigue (d = 1.06; P < .001) and overall quality of life (d = 1.15; P = .005) than those assigned to WLC. More patients randomized to CBT-TTF than WLC demonstrated clinically significant improvements in fatigue (85% vs 29%) and quality of life (88% vs 54%; P values ≤ .016). CONCLUSIONS: CBT-TTF displays preliminary efficacy in improving fatigue and quality of life among fatigued patients with CML treated with TKIs. The findings suggest that a larger randomized study is warranted.

5.
Cancer Nurs ; 2019 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-31833920

RESUMO

BACKGROUND: Despite the stress inherent in a cancer diagnosis, many cancer survivors report benefits, including perceptions of personal growth and well-being. Among adults 60 years or older, for whom cancer diagnoses are most prevalent, there is a notable lack of research on positive psychological change. OBJECTIVE: This mixed-methods study was designed to advance current understanding of positive psychology (ie, posttraumatic growth, well-being) in older adults with cancer. METHODS: Fifty-six older adult cancer survivors were recruited through a statewide cancer registry and the community. Participants completed questionnaires on posttraumatic growth, well-being, coping, and quality of life, as well as a series of open-ended questions via mail. RESULTS: Participants reported high posttraumatic growth and well-being and primarily adaptive and emotion-focused coping strategies. They also reported better mental quality of life (P = .0001) but not physical quality of life (P = .31) compared with age-adjusted population norms. Older age was associated with less posttraumatic growth (r = -0.32, P = .02) but not well-being (P = .34). Qualitative responses emphasized appreciation and acceptance and a reliance on faith and social support and provided context for quantitative results. CONCLUSIONS: This mixed-methods study suggests that older adults report positive psychological change and adaptive coping with cancer, demonstrating their high level of emotional resilience. IMPLICATIONS FOR PRACTICE: Mental health screenings should be provided as appropriate, but oncology nurses should also consider the potential for positive psychological change postdiagnosis. The provision of care and social support may need to be modified to accommodate older cancer survivors' needs.

6.
Cancer ; 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31860135

RESUMO

BACKGROUND: Little is known about longitudinal symptom burden, its consequences for well-being, and whether lifestyle moderates the burden in older survivors. METHODS: The authors report on 36-month data from survivors aged ≥60 years with newly diagnosed, nonmetastatic breast cancer and noncancer controls recruited from August 2010 through June 2016. Symptom burden was measured as the sum of self-reported symptoms/diseases as follows: pain (yes or no), fatigue (on the Functional Assessment of Cancer Therapy [FACT]-Fatigue scale), cognitive (on the FACT-Cognitive scale), sleep problems (yes or no), depression (on the Center for Epidemiologic Studies Depression scale), anxiety (on the State-Trait Anxiety Inventory), and cardiac problems and neuropathy (yes or no). Well-being was measured using the FACT-General scale, with scores from 0 to 100. Lifestyle included smoking, alcohol use, body mass index, physical activity, and leisure activities. Mixed models assessed relations between treatment group (chemotherapy with or without hormone therapy, hormone therapy only, and controls) and symptom burden, lifestyle, and covariates. Separate models tested the effects of fluctuations in symptom burden and lifestyle on function. RESULTS: All groups reported high baseline symptoms, and levels remained high over time; differences between survivors and controls were most notable for cognitive and sleep problems, anxiety, and neuropathy. The adjusted burden score was highest among chemotherapy-exposed survivors, followed by hormone therapy-exposed survivors versus controls (P < .001). The burden score was related to physical, emotional, and functional well-being (eg, survivors with lower vs higher burden scores had 12.4-point higher physical well-being scores). The composite lifestyle score was not related to symptom burden or well-being, but physical activity was significantly associated with each outcome (P < .005). CONCLUSIONS: Cancer and its treatments are associated with a higher level of actionable symptoms and greater loss of well-being over time in older breast cancer survivors than in comparable noncancer populations, suggesting the need for surveillance and opportunities for intervention.

8.
Psychooncology ; 28(11): 2174-2180, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31418499

RESUMO

OBJECTIVE: Cancer and its treatment are associated with long-term cognitive deficits. However, most studies of cancer patients have used traditional, office-based cognitive evaluations instead of assessing patients in their daily lives. Recent research in cognitive aging suggests that variability in performance may be a sensitive indicator of cognitive decline. Using ecological momentary assessment (EMA), we examined cognitive variability among breast cancer survivors and evaluated whether ratings of fatigue and depressed mood were associated with cognition. METHODS: Participants were 47 women (M age = 53.3 years) who completed treatment for early stage breast cancer 6 to 36 months previously. Smartphones were preloaded with cognitive tests measuring processing speed, executive functioning, and memory, as well as rating scales for fatigue and depressed mood. Participants were prompted five times per day over a 14-day period to complete EMA cognitive tasks and fatigue and depressed mood ratings. RESULTS: Cognitive variability was observed across all three EMA cognitive tasks. Processing speed responses were slower at times that women rated themselves as more fatigued than their average (P < .001). Ratings of depressed mood were not associated with cognition. CONCLUSIONS: This study is the first to report cognitive variability in the daily lives of women treated for breast cancer. Performance was worse on a measure of processing speed at times when a woman rated her fatigue as greater than her own average. The ability to identify moments when cognition is most vulnerable may allow for personalized interventions to be applied at times when they are most needed.

9.
J Pain Symptom Manage ; 58(2): 289-296.e2, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31121250

RESUMO

CONTEXT: The Hospital Anxiety and Depression Scale (HADS) is a brief self-report measure commonly used to screen for symptoms of anxiety and depression in cancer patients. The HADS has demonstrated validity in over 100 languages, including Spanish. However, validation studies have largely used European Spanish-speaking samples with a variety of medical diagnoses. OBJECTIVES: The aim of this study was to examine the psychometric properties of the Spanish version of the HADS in a sample of Spanish-speaking Latina women with cancer in the U.S. METHODS: Participants (N = 242) completed self-report measures of anxiety and depression (HADS), quality of life (Functional Assessment of Cancer Therapy-General Version), cancer-related distress (Impact of Events Scale-Revised Version Intrusion Subscale), and cancer symptomatology (Memorial Symptom Assessment Scale-Short Form) before initiating chemotherapy and five to seven weeks later. Analyses evaluated internal consistency and test-retest reliability, construct validity, and convergent validity. RESULTS: Factor analysis supported a two-factor structure as proposed by the original HADS developers (X2 [76, N = 242] = 143.3, P < 0.001, comparative fit index = 0.94, root-mean-square error of approximation = 0.06, and standardized root-mean-square residual = 0.06). The HADS and its subscales demonstrated good internal consistency (α = 0.83-0.88) and test-retest reliability (intraclass correlation coefficient = 0.76-0.82). Construct validity was evidenced by factor analysis and item-subscale, item-total, and subscale-total correlations. Convergent validity was demonstrated by strong positive correlations with cancer-related distress (r = 0.51-0.71) and symptom severity (r = 0.54-0.62) and strong negative correlations with quality of life (r = -0.63 to -0.76) (all P's < 0.001). CONCLUSION: The Spanish version of the HADS evidenced sound psychometric properties in Latinas with cancer in the U.S., supporting its use in clinical oncology research and practice.

10.
Psychooncology ; 28(6): 1234-1242, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30932275

RESUMO

OBJECTIVE: Loneliness, or the discrepancy between perceived and desired level of social connectedness, is an understudied but important psychosocial factor in cancer patients. The current study investigated the relationship between loneliness, depressive symptoms, quality of life, and social cognitive variables (eg, stigma, social constraint, and cancer-related negative social expectations), and explored loneliness as a mediator of the relationship between social cognitive variables and depressive symptoms and quality of life in lung cancer patients beginning treatment. METHODS: Patients within 3 months of beginning treatment for lung cancer completed measures of loneliness, depressive symptoms, quality of life, and social cognitive variables. Correlational, chi-square, and hierarchical regression analyses evaluated relationships among variables. Bias-corrected bootstrapping methods estimated the indirect effect and 95% confidence interval for mediation models. RESULTS: Participants (n = 105, M = 65.5 years, 55% female) endorsed low to moderate levels of loneliness. Greater loneliness was associated with greater depressive symptoms and worse quality of life (P's < .001), and loneliness explained unique variance in depressive symptoms (F = 10.18, P < .001, ΔR2  = .06, Total R2  = .35) and quality of life (F = 19.55, P < .001, ΔR2  = .05, Total R2  = .52) after controlling for significant covariates. Greater stigma, social constraint, and cancer-related negative social expectations were associated with greater loneliness and depressive symptoms and worse quality of life (P's < .001). Loneliness partially mediated the relationship of social cognitive variables with depressive symptoms and quality of life. CONCLUSIONS: Beyond its direct impact on clinically relevant outcomes, the experience of loneliness may be a mechanism by which social cognitive factors influence depressive symptoms and quality of life in lung cancer patients.

11.
Brain Behav Immun ; 80: 308-314, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30953767

RESUMO

BACKGROUND: Cognitive decline is a frequently cited concern among patients receiving hematopoietic cell transplantation (HCT), and patients often experience neurocognitive deficits (i.e., stable or worsening neurocognitive performance) throughout the transplant course. Deficits can be most severe during the acute transplant period (i.e., 90 days after transplantation), when patients also typically experience elevated systemic levels of inflammation. Previous studies have identified inflammation as a likely mechanism underlying neurocognitive deficits, primarily in women with breast cancer; however, longitudinal studies have been limited. In this study, our aim was to evaluate the relationship between changes in systemic inflammation and changes in cognition from pre- to post-transplant in patients receiving allogeneic HCT. METHODS: Patients scheduled for allogeneic HCT (n = 85) were assessed prior to HCT and 90 days after HCT. Biomarkers of inflammation included IL-6, sTNF-RII, CRP, and IL-1ra, which have been previously associated with neurocognitive deficits in cancer patients. Patients completed neuropsychological testing and self-report questionnaires. RESULTS: Mixed models demonstrated that from pre- to post-HCT, increases in IL-6 and sTNF-RII were associated with neurocognitive deficits, and decreases in CRP were associated with better neurocognitive performance. There were no significant associations between changes in inflammation and self-reported cognitive performance. CONCLUSIONS: Our findings are the first to our knowledge to report a robust relationship between increasing inflammation and neurocognitive deficits from pre- to post-HCT. Additional studies are needed to confirm these findings in a larger sample.

12.
J Clin Psychol Med Settings ; 26(4): 440-448, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30747340

RESUMO

Treatment-related fatigue significantly limits quality of life among chronic myeloid leukemia (CML) patients receiving tyrosine kinase inhibitors (TKIs), yet no interventions to reduce this symptom have been studied. We examined preliminary feasibility and efficacy of cognitive behavioral therapy for TKI treatment-related fatigue in patients with CML. We used a mixed methods convergent design and collected quantitative data through randomized single-case experiments. We included CML patients receiving TKIs and reporting severe fatigue. Within each participant, we compared CBT to a no-treatment baseline period. Fatigue severity was measured weekly with the Checklist Individual Strength. Fatigue scores were subjected to visual analyses and randomization tests for single-case experimental designs. We conducted qualitative interviews after study participation and focused on feasibility and efficacy of CBT. Visual inspection of line graphs indicated downward trends in the expected direction for fatigue in two of the four participants. The test statistics showed a decrease in fatigue severity for all participants but randomization tests did not reach statistical significance (overall p = 0.18). Participants reported qualitative improvements in level of functioning and coping with fatigue. CBT was considered feasible and acceptable for severely fatigued CML patients. Our study provided preliminary evidence for the feasibility and acceptability of CBT for severely fatigued CML patients receiving targeted therapy. We recommend further efficacy testing of this promising intervention in a pilot randomized controlled trial.

13.
J Pain Symptom Manage ; 57(4): 816-819, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30703463

RESUMO

CONTEXT: Cancer-related pain is a common symptom that is often treated with opioids. However, legislation aimed at containing the opioid crisis, coupled with public fears about opioid risks, may contribute to opioid stigma in cancer patients. To our knowledge, no prior research has examined opioid stigma and stigma-related behavior in this population. OBJECTIVE: The objectives of this study were to describe opioid use, including reasons for use and overuse and underuse behavior; characterize opioid stigma; and identify potentially maladaptive stigma-related behaviors. METHODS: Participants were 125 adults undergoing active cancer treatment seen at the Moffitt Supportive Care Medicine Clinic. Patients completed a brief, anonymous questionnaire evaluating opioid use, opioid stigma, and stigma-related behaviors. RESULTS: Patients were primarily women (65%) aged 45-64 years (49%), most commonly diagnosed with breast (23%) and hematologic (15%) cancer. Among patients who reported opioid use (n = 109), the most common reason for use was pain relief (94%), followed by improved sleep (25%). A subset of patients reported using less (13%) or more (8%) opioid medication than advised. Opioid stigma was endorsed by 59/97 patients prescribed opioids (61%), including fear of addiction (36%), difficulty filling prescriptions (22%), and awkwardness communicating with providers (15%). Stigma-related behaviors were endorsed by 28 (29%) respondents prescribed opioids, with "taking less opioid medication than needed" as the most commonly endorsed behavior (20%). CONCLUSION: To our knowledge, this study provides the first evidence of opioid stigma and its consequences in cancer patients and offers potential targets for interventions aimed at reducing stigma and encouraging safe, effective opioid use.

14.
J Pain Symptom Manage ; 57(5): 952-960.e1, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30711631

RESUMO

CONTEXT: Quality of life (QoL) is increasingly recognized as an important outcome of cancer treatment. Previous studies have examined clinical predictors of QoL, but with the increasing prevalence of wearable sensors that monitor sleep and activity patterns, further investigation into whether these behaviors are predictive of post-treatment QoL is now feasible. Among patients receiving aggressive cancer treatment such as hematopoietic cell transplantation (HCT), analysis of circadian rhythms (24-hour patterns of sleep and activity) via wearable sensors is limited. OBJECTIVE: To evaluate the relationship between overall QoL and circadian rhythms in patients receiving allogeneic HCT. METHODS: Patients wore an ActiGraph GT3X (Pensacola, FL) activity monitor for at least 72 hours before the initiation of conditioning chemotherapy and transplantation and completed a QoL (Functional Assessment of Cancer Therapy-General [FACT-G]) assessment. QoL assessments were also completed 1, 3, and 6 months after HCT. RESULTS: Patients (n = 45, M age = 55) were mostly male (66%) with a total FACT-G score of 80.96 (SD = 16.05) before HCT. Mixed models revealed robust cross-sectional associations between overall QoL and multiple circadian rhythmicity parameters, including durations of high physical activity, overall circadian rhythmicity, and earlier starts of daily activity (P's < .01). Recovery of QoL after transplant was predicted by longer pre-transplant durations of high physical activity (P = .04) and earlier evening retirement (P = .04). CONCLUSION: Our findings suggest that wearable sensor information is a promising method of predicting recovery of QoL after HCT. Additional studies are needed to confirm these findings in a larger sample.

16.
J Pain Symptom Manage ; 57(3): 596-606, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30472317

RESUMO

CONTEXT: Symptoms affect quality of life (QOL), functional status, and cognitive function in cancer survivors, but older survivors are understudied. OBJECTIVES: The objectives of this study were to identify prototypical presystemic therapy psychoneurological symptom clusters among older breast cancer survivors and determine whether these symptom clusters predicted cognition and QOL over time. METHODS: Women with newly diagnosed nonmetastatic breast cancer (n = 319) and matched noncancer controls (n = 347) aged 60+ years completed questionnaires and neuropsychological tests before systemic therapy and 12 and 24 months later. Latent class analysis identified clusters of survivors based on their pretherapy depression, anxiety, fatigue, sleep disturbance, and pain. Linear mixed-effects models examined changes in objective cognition, perceived cognition, and functional status (Instrumental Activities of Daily Living disability, functional well-being, and breast cancer-specific QOL) by group, controlling for covariates. RESULTS: Nearly one-fifth of older survivors were classified as having high pretherapy symptoms (n = 51; 16%); the remainder had low symptoms (n = 268; 84%); both groups improved over time on all outcomes. However, compared to the low symptom group and controls, survivors with high symptoms had lower baseline objective cognition and lower perceived cognition at baseline and 24 months, lower functional well-being at baseline and 12 months, greater Instrumental Activities of Daily Living disability at baseline, and lower breast cancer-specific QOL at all time points (all P < 0.05). CONCLUSION: Nearly one-fifth of older breast cancer survivors had high psychoneurological symptoms at diagnosis, which predicted clinically meaningful decrements in perceived cognition and function in the first 24 months after diagnosis. Pretreatment psychoneurological symptom clusters could identify survivors for monitoring or intervention.

17.
Gynecol Oncol ; 152(2): 310-315, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30558975

RESUMO

OBJECTIVE: Increasing age has been associated with higher risk of chemotherapy-related toxicities, often resulting in treatment disruptions or discontinuations. Age has also been evaluated as a potential risk factor for chemotherapy-induced peripheral neuropathy (CIPN), but current understanding of recovery from CIPN in older adults after treatment is limited. The goal of the current study was to: 1) evaluate longitudinal change in patient-reported CIPN symptoms from the start of chemotherapy to one year post-chemotherapy; and 2) examine treatment modifications in older (≥65 years) and younger patients (<65 years). METHODS: As part of a larger ongoing study, gynecologic cancer patients (n = 90) treated with cytoxic chemotherapy reported their CIPN symptoms via the EORTC-CIPN20 three times during active treatment and at 6 and 12 months post-treatment. Medical record reviews were conducted to abstract clinical information during active treatment. RESULTS: Piecewise mixed models revealed that older and younger patients reported similar increases in CIPN during the active treatment phase. However, older patients did not recover from CIPN after treatment completion, whereas younger patients exhibited significant declines in CIPN symptoms post-treatment. No age differences were observed in the presence of provider-recorded sensory neuropathy and pain; neuropathy-related treatment delays, changes in chemotherapy dose, regimen, or discontinuations; or falls (all p-values > 0.05). CONCLUSIONS: Results from the current study indicate that older adults are at higher risk for chronic CIPN. Older survivors may require additional education and treatment for chronic CIPN symptoms. Additional studies are needed to explore novel interventions to manage chronic CIPN in older cancer survivors.


Assuntos
Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Neoplasias dos Genitais Femininos/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Fatores Etários , Idoso , Feminino , Humanos , Infusões Intravenosas , Infusões Parenterais , Estudos Longitudinais , Pessoa de Meia-Idade , Modelos Estatísticos , Fatores Socioeconômicos
18.
Biol Blood Marrow Transplant ; 25(1): 145-150, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30098393

RESUMO

Hematopoietic cell transplant (HCT) can cause significant distress in patients and their informal caregivers. Despite advances in reduced-intensity conditioning and supportive care, few recent studies have reported rates of clinically significant post-traumatic stress disorder (PTSD) symptomatology. Goals of the current study were to examine rates of PTSD and distress in patients and caregivers and to identify sociodemographic and clinical risk factors for PTSD. As part of an annual survivorship survey, 2157 HCT recipients and their caregivers were mailed self-report measures of PTSD and distress. Patients also completed self-report measures of sociodemographic information (eg, age, sex, employment status). Clinical variables (eg, time since transplant, transplant type) were captured in the transplant database. A total of 691 recipients (56% age 60 or above at the time of survey, 47% women, median 10.1 years post-HCT) and 333 caregivers provided PTSD data and were included in the current analyses. More caregivers reported PTSD (6.6%) than patients (3.3%; P = .02). Patients or caregivers who had PTSD reported significantly higher distress related to uncertainty, family strain, medical demands, finances, identity, and health burden (P < .0001) compared with those without PTSD. Patient but not caregiver PTSD was associated with more recent transplant (P = .01 and P = .16, respectively). Rates of PTSD are relatively low in long-term survivors of HCT and their caregivers. Nevertheless, results are consistent with other studies of cancer caregiving suggesting that caregivers often experience greater distress than patients. Timely referral to psychosocial services should be offered to both HCT recipients and caregivers reporting symptoms of PTSD.


Assuntos
Cuidadores , Transplante de Células-Tronco Hematopoéticas/psicologia , Neoplasias , Transtornos de Estresse Pós-Traumáticos , Estresse Psicológico , Condicionamento Pré-Transplante/psicologia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/psicologia , Neoplasias/terapia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia
20.
Haematologica ; 103(9): 1535-1541, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29858386

RESUMO

Chronic graft-versus-host disease occurs in 20-50% of allogeneic hematopoietic cell transplant survivors. We surveyed patients about their quality of life, symptoms, health status, comorbid conditions and medications. Instruments included the Short-Form-36 (SF-36), the Patient-Reported Outcomes Measurement Information System (PROMIS) Global and PROMIS-29 scales and the Lee Chronic Graft-versus-Host Disease Symptom Scale. Functional status was measured by self-reported Karnofsky performance status and work status. Of 3027 surveys sent to recipients surviving one or more years after transplantation, 1377 (45%) were returned. Among these, patients reported that their chronic graft-versus-host disease was mild (n=257, 18.7%), moderate (n=110, 8.0%) or severe (n=25, 1.8%). Another 377 (27.4%) had never had chronic graft-versus-host disease and 280 (20.3%) had had chronic graft-versus-host disease but it had resolved. We excluded 328 (23.8%) patients who did not answer the questions about chronic graft-versus-host disease. Patients who reported moderate or severe chronic graft-versus-host disease reported worse quality of life, lower performance status, a higher symptom burden and were more likely to be taking prescription medications for pain, anxiety and depression compared to those with resolved chronic graft-versus-host disease. Self-reported measures were similar between patients with resolved chronic graft-versus-host disease and those who had never had it. Our data suggest that the PROMIS measures may be able to replace the SF-36 in the assessment of chronic graft-versus-host disease. Between 26.7-39.4% of people with active chronic graft-versus-host disease were unable to work due to health reasons, compared with 12.1% whose chronic graft-versus-host disease had resolved and 15.4% who had never had chronic graft-versus-host disease. Mouth, eye and nutritional symptoms persisted after resolution of chronic graft-versus-host disease. These results show that better prevention of and treatment for chronic graft-versus-host disease are needed to improve survivorship after allogeneic transplantation.


Assuntos
Doença Enxerto-Hospedeiro/epidemiologia , Nível de Saúde , Qualidade de Vida , Adulto , Doença Crônica , Feminino , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/etiologia , Pesquisas sobre Serviços de Saúde , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Fatores de Risco , Índice de Gravidade de Doença , Transplante Homólogo
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