Late effects of hematopoietic cell transplantation among 10-year adult survivors compared with case-matched controls
Late effects of hematopoietic cell transplantation among 10-year adult survivors compared with case-matched controls
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DOI：
10.1200/jco.2005.12.674
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发表时间：
2005-09-20
影响因子：
45.3
通讯作者：
Martin, PJ
中科院分区：
文献类型：
--
作者：
Syrjala, KL;Langer, SL;Martin, PJ
目的 确定造血细胞移植 (HCT) 对 10 年幸存者的健康问题和健康相关生活质量的后期影响。患者和方法 455 名成年人在 HCT 前同意这项研究。前瞻性地维护医疗记录和标准化自我报告措施。 10 年后，137 名幸存者和非移植对照组在年龄、性别和种族方面进行了病例匹配，完成了医疗问题、症状和健康相关生活质量的自我报告。结果幸存者和对照组的住院率和大多数疾病相似，但幸存者报告平均有 3.5 个医疗问题，而对照组为 1.7 个 (P < .001)。幸存者报告更多的肌肉骨骼僵硬、抽筋、虚弱和关节肿胀 (P < .001)、白内障手术 (P < .001)、丙型肝炎 (P = .004)、男性 (P = .01) 和女性 (P < .001) 的性问题、社交功能限制 (P = .002)、记忆力和注意力问题 (P = .003)、尿频或漏尿 (P = .006）、使用精神药物（P = .009）以及拒绝人寿和健康保险（P < .001）。幸存者和对照组在骨质疏松症、甲状腺功能减退症、就业、婚姻满意度、离婚或心理健康的自我报告率方面没有差异。 结论 尽管在许多方面没有区别，但幸存者比对照组有更多的医疗需求。健康问题并不集中于特定疾病或仅限于具有易于识别的危险因素的幸存者。肌肉骨骼问题需要筛查和研究病因以及有效的治疗方法。骨质疏松症和甲状腺功能减退症可能未被充分诊断。幸存者需要筛查性问题、尿频、情绪以及是否需要抗抑郁药或苯二氮卓类药物。
Purpose To determine late effects of hematopoietic cell transplantation (HCT) on health problems and health-related quality of life for 10-year survivors.Patients and Methods Four hundred five adults consented to the study before HCT. Medical records and standardized self-report measures were maintained prospectively. After 10 years, 137 survivors and nontransplant controls, case-matched on age, sex, and race, completed self-report of medical problems, symptoms, and health-related quality of life.Results Survivors and controls had similar rates of hospitalization and most diseases, but survivors reported an average of 3.5 medical problems versus 1.7 for controls (P < .001). Survivors reported more musculoskeletal stiffness, cramps, weakness and joint swelling (P < .001), cataract surgery (P < .001), hepatitis C (P = .004), sexual problems for men (P = .01) and women (P < .001), restrictions in social function (P = .002), memory and attention concerns (P = .003), urinary frequency or leaking (P = .006), use of psychotropic medication (P = .009), and denial of life and health insurance (P < .001). Survivors and controls did not differ in self-reported rates of osteoporosis, hypothyroidism, employment, marital satisfaction, divorce, or psychological health.Conclusion Although indistinguishable in many respects, survivors had more medical needs than controls. Health problems were not focused on specific diseases or limited to survivors with readily identifiable risk factors. Musculoskeletal problems require both screening and research into etiologies and effective treatments. Osteoporosis and hypothyroidism may be underdiagnosed. Survivors require screening for sexual problems, urinary frequency, mood and need for antidepressants or benzodiazepines.