Peter Esser1, Katharina Kuba2, Angela Scherwath3, Christoffer Johansen4, Anke Schwinn3, Lena Schirmer3, Frank Schulz-Kindermann3, Margitta Kruse5, Uwe Koch3, Axel Rolf Zander6, Nicolaus Kröger7, Heide Götze2, Anja Mehnert8. 1. Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany. Electronic address: peter.esser@medizin.uni-leipzig.de. 2. Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany. 3. Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 4. Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany; Oncology Clinic, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Unit of Survivorship, The Danish Cancer Society Research Center, Copenhagen, Denmark. 5. Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover, Germany. 6. Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Huntsman Cancer Institute, University of Utah, Salt Lake City, USA. 7. Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 8. Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany; Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Abstract
CONTEXT: Due to toxicity and invasiveness, allogeneic hematopoietic stem cell transplantation causes severe and longstanding symptom burden. Longitudinal studies on symptoms and symptom clusters (SC) would be helpful to optimize symptom control but are rare to date. OBJECTIVES: The objective of this study was to investigate stability of symptoms, extract time stable SC, and determine their priority in symptom management. METHODS: In this multicenter study, patients diagnosed with hematologic cancer were assessed before conditioning (T0) and three months (T1), one year (T2), and five years (T3) after transplantation. Symptoms were assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Symptoms were stable when rated as present at three consecutive time points. Applying factor analysis, stable SC were composed of symptoms loading on the same factor across all time points. Priority in symptom management was derived from a combination of severity and predictive power for quality of life (QoL). RESULTS: Two hundred thirty-nine patients participated at T0, 150 (63%) at T1, 102 (43%) at T2, and 45 (19%) at T3. We identified three stable SC, composed of rest-tired-weak-dyspnea-loss of appetite (exhausted), tense-worried-irritable-depressed (affective), and nausea-vomiting (gastrointestinal). Fatigue was most persistent and also most severe and predictive for QoL, both as symptom and in cluster (exhausted). CONCLUSION: Given its high stability, severity, and impact on QoL, fatigue should have priority in symptom management. The treatment of this symptom could be enhanced by also incorporating interventions addressing dyspnea and loss of appetite.
CONTEXT: Due to toxicity and invasiveness, allogeneic hematopoietic stem cell transplantation causes severe and longstanding symptom burden. Longitudinal studies on symptoms and symptom clusters (SC) would be helpful to optimize symptom control but are rare to date. OBJECTIVES: The objective of this study was to investigate stability of symptoms, extract time stable SC, and determine their priority in symptom management. METHODS: In this multicenter study, patients diagnosed with hematologic cancer were assessed before conditioning (T0) and three months (T1), one year (T2), and five years (T3) after transplantation. Symptoms were assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Symptoms were stable when rated as present at three consecutive time points. Applying factor analysis, stable SC were composed of symptoms loading on the same factor across all time points. Priority in symptom management was derived from a combination of severity and predictive power for quality of life (QoL). RESULTS: Two hundred thirty-nine patients participated at T0, 150 (63%) at T1, 102 (43%) at T2, and 45 (19%) at T3. We identified three stable SC, composed of rest-tired-weak-dyspnea-loss of appetite (exhausted), tense-worried-irritable-depressed (affective), and nausea-vomiting (gastrointestinal). Fatigue was most persistent and also most severe and predictive for QoL, both as symptom and in cluster (exhausted). CONCLUSION: Given its high stability, severity, and impact on QoL, fatigue should have priority in symptom management. The treatment of this symptom could be enhanced by also incorporating interventions addressing dyspnea and loss of appetite.
Authors: Ashley Leak Bryant; Erin Coffman; Brett Phillips; Xianming Tan; Elizabeth Bullard; Rachel Hirschey; Joshua Bradley; Antonia V Bennett; Angela M Stover; Lixin Song; Thomas C Shea; William A Wood Journal: Support Care Cancer Date: 2019-06-20 Impact factor: 3.603
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Authors: Katharina Kuba; Gregor Weißflog; Heide Götze; Francisco García-Torres; Anja Mehnert; Peter Esser Journal: Int J Clin Health Psychol Date: 2019-01-16
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