Quality of life and mood predict posttraumatic stress disorder after hematopoietic stem cell transplantation.
Quality of life and mood predict posttraumatic stress disorder after hematopoietic stem cell transplantation.
复制标题
DOI：
10.1002/cncr.29818
复制
发表时间：
2016-03-01
期刊：
影响因子：
6.2
通讯作者：
Temel JS
中科院分区：
文献类型：
--
作者：
El-Jawahri AR;Vandusen HB;Traeger LN;Fishbein JN;Keenan T;Gallagher ER;Greer JA;Pirl WF;Jackson VA;Spitzer TR;Chen YB;Temel JS
在造血干细胞移植（HCT）住院期间，患者的生活质量（QOL）和情绪急剧恶化。这种恶化对患者HCT后QOL和创伤后应激障碍（PTSD）症状的影响尚不清楚。我们对因HCT住院的患者进行了一项前瞻性纵向研究。我们在HCT入院时、住院期间和HCT后6个月评估了QOL（癌症治疗功能评估-骨髓移植[FACT-BMT]）以及抑郁和焦虑症状（患者健康问卷-9（PHQ-9））。我们还使用医院焦虑和抑郁量表（HADS）来测量患者在基线和HCT住院期间的焦虑和抑郁症状。我们使用PTSD检查表来评估PTSD症状。我们使用多变量线性回归模型来确定六个月时QOL和PTSD症状的预测因子。我们入组了97%（90/93）连续合格的接受自体和同种异体HCT的患者。67名参与者的6个月数据可用。在6个月时，28.4%的参与者符合PTSD的标准，43.3%的参与者有临床显著的抑郁症。在校正显著协变量的多变量回归分析中，HCT住院第2周至基线的QOL和抑郁评分变化预测QOL较差HCT后6个月时的PTSD症状（ΔQOL β=-0.94，P < 0.0001，ΔPHQ-9 β=-2.59，P = 0.001）和PTSD症状（ΔQOL β=-0.40，P < 0.0001，ΔPHQ-9 β= 1.26，P < 0.0001）。HCT后6个月，有相当比例的患者符合PTSD和抑郁症的标准。HCT住院期间生活质量下降和抑郁症状增加是6个月生活质量受损和PTSD症状的最重要预测因素。因此，在HCT住院期间管理抑郁症状和QOL恶化可能对改善6个月时的QOL和降低PTSD的风险至关重要。
During hospitalization for hematopoietic stem cell transplantation (HCT), patients experience a steep deterioration in quality of life (QOL) and mood. The impact of this deterioration on patients’ post-HCT QOL and post-traumatic stress disorder (PTSD) symptoms is unknown. We conducted a prospective longitudinal study of patients hospitalized for HCT. We assessed QOL (Functional Assessment of Cancer Therapy-Bone Marrow Transplantation [FACT-BMT]) and depression and anxiety symptoms (Patient Health Questionnaire-9 (PHQ-9)) at the time of admission for HCT, during hospitalization, and 6-month post-HCT. We also used the Hospital Anxiety and Depression Scale (HADS) to measure patients’ anxiety and depression symptoms at baseline and during HCT hospitalization. We used the PTSD Checklist to assess for PTSD symptoms. We used multivariable linear regression models to identify predictors of QOL and PTSD symptoms at six months. We enrolled 97% (90/93) of consecutively eligible patients undergoing autologous and allogeneic HCT. Data at six months were available for 67 participants. At six months, 28.4% of participants met criteria for PTSD and 43.3% had clinically significant depression. In multivariable regression analyses adjusting for significant covariates, change in QOL and depression scores from week-2 of HCT hospitalization to baseline predicted worse QOL (ΔQOL β= 0.94, P < 0.0001, ΔPHQ-9 β= −2.59, P = 0.001) and PTSD symptoms (ΔQOL β= −0.40, P < 0.0001, ΔPHQ-9 β= 1.26, P < 0.0001) at six months post-HCT. Six months after HCT, a significant proportion of patients met criteria for PTSD and depression. Decline in QOL and increase in depressive symptoms during hospitalization for HCT were the most important predictors of 6-month QOL impairment and PTSD symptoms. Therefore, managing depression symptoms and QOL deterioration during HCT hospitalization may be critical to improving QOL at six months and reduce the risk of PTSD.