Quality of Life Immediately After PBSCT
Quality of Life Immediately After PBSCT
This prospective, longitudinal study investigated the quality of life among patients immediately after undergoing peripheral blood stem cell transplantation. The patients were assessed before transplantation (n = 16), immediately before hospital discharge (n = 10), 2 weeks after hospital discharge (n = 10), and 6 weeks after hospital discharge (n = 8). Patients completed the European Organization for Research and Training Quality of Life Questionnaire-Core 30 and the Ferrans and Powers Quality of Life Index at each assessment point. A brief telephone interview was conducted 6 weeks after hospitalization (n = 7). The study results indicate that patients undergoing peripheral blood stem cell transplantation experience significant appetite loss (P < .01), diarrhea (P < .05), nausea and vomiting (P < .05), and sleep disturbances (P < .01) during the acute posttransplantation period. Other clinically important changes also were identified, so that a general pattern of recovery emerged. These patients reported diminished functional ability, increased symptoms, and poorer quality of life immediately before hospital discharge, with a return to pretransplantation levels by 6 weeks after hospitalization. In contrast, life satisfaction continued to decline 2 weeks after hospitalization, but did improve by 6 weeks. The qualitative data provide further support for this trend.
Peripheral blood stem cell transplantation (PBSCT) procedure and high-dose chemotherapy with or without total body irradiation have the potential to have an impact on all aspects of a patient's life, particularly during the immediate posttransplantation period. Because PBSCT is a relatively recent development, there is a paucity of information regarding quality of life (QOL) issues among PBSCT recipients. Only eight studies evaluating QOL among PBSCT patients were identified in the literature. Most of these have been published within the past 2 years.
Reflecting the growing sophistication of QOL studies, four of these eight studies used a prospective, longitudinal design to detect changes in QOL. Three longitudinal studies examined QOL in the acute posttransplantation experience. However, these studies exclusively examined QOL in patients with breast cancer undergoing autologous PBSCT. A fourth study included patients undergoing allogeneic and autologous PBSCT, but did not examine QOL in the acute posttransplantation period.
No studies found in the literature examined QOL in allogeneic and autologous patients during the immediate posttransplantation period. This information is needed to provide a better understanding of the problems experienced by patients during the immediate posttransplantation period so effective interventions can be planned to mitigate them. This information also can be used to identify patients at greater risk for problems so interventions can be initiated as early as possible to increase the likelihood of successful outcomes.
In terms of a source for stem cells, there is increasing evidence that transplanting peripheral blood stem cells rather than stem cells obtained from bone marrow results in accelerated hematopoietic reconstitution. The possible benefits of PBSCT include prompt hematology recovery, shorter hospital stays, and decreased cost. Nonetheless, patients may experience a number of side effects from the marrow ablative therapy and subsequent infusion of autologous or allogeneic peripheral blood stem cells.
Several studies have reported deterioration in physical health status, physical functioning, role functioning, social functioning, and global QOL immediately after the high-dose chemotherapy and PBSCT. In one study, more than 60% of the patients reported a high number of symptoms including fatigue, hair loss, appetite loss, nausea, change in taste, vomiting, fever, and weight loss. Improvement in physical health status has been reported as early as 7 to15 weeks after hospitalization, with most QOL scores returning to the baseline score within 1 year after the treatment. There is, however, conflicting data regarding improvement in physical functioning 1 year after transplantation.
From these studies, a general trend of deterioration in QOL scores after the high-dose chemotherapy followed by improvement can be identified. A more precise trend in terms of length and speed of perceived physical recovery cannot be determined because the method of QOL assessment, time of QOL assessment, and treatment administration differed in each study. Because three of the longitudinal studies focused on patients with breast cancer, these study findings cannot be generalized to males, females with diagnoses other than breast cancer, or allogeneic PBSCT patients. As a result, further study into the trajectory of recovery during the acute posttransplantation period is needed. This prospective, longitudinal study aimed to describe the patient's QOL immediately after the PBSCT, and to describe the trajectory of changes during the transition from hospital to home. The findings from this preliminary study will be used to design a larger multisite study.
The Ferrans' conceptual quality-of-life model was used as a framework to guide the study. Quality of life was assessed in terms of health and functioning, psychological and spiritual, social, economic, and family aspects of life on the basis of domains identified in the model. The model is consistent with the current QOL literature about patients with cancer in that QOL is dynamic, multidimensional, and entails the domains of QOL that generally are recognized in the literature.
This prospective, longitudinal study investigated the quality of life among patients immediately after undergoing peripheral blood stem cell transplantation. The patients were assessed before transplantation (n = 16), immediately before hospital discharge (n = 10), 2 weeks after hospital discharge (n = 10), and 6 weeks after hospital discharge (n = 8). Patients completed the European Organization for Research and Training Quality of Life Questionnaire-Core 30 and the Ferrans and Powers Quality of Life Index at each assessment point. A brief telephone interview was conducted 6 weeks after hospitalization (n = 7). The study results indicate that patients undergoing peripheral blood stem cell transplantation experience significant appetite loss (P < .01), diarrhea (P < .05), nausea and vomiting (P < .05), and sleep disturbances (P < .01) during the acute posttransplantation period. Other clinically important changes also were identified, so that a general pattern of recovery emerged. These patients reported diminished functional ability, increased symptoms, and poorer quality of life immediately before hospital discharge, with a return to pretransplantation levels by 6 weeks after hospitalization. In contrast, life satisfaction continued to decline 2 weeks after hospitalization, but did improve by 6 weeks. The qualitative data provide further support for this trend.
Peripheral blood stem cell transplantation (PBSCT) procedure and high-dose chemotherapy with or without total body irradiation have the potential to have an impact on all aspects of a patient's life, particularly during the immediate posttransplantation period. Because PBSCT is a relatively recent development, there is a paucity of information regarding quality of life (QOL) issues among PBSCT recipients. Only eight studies evaluating QOL among PBSCT patients were identified in the literature. Most of these have been published within the past 2 years.
Reflecting the growing sophistication of QOL studies, four of these eight studies used a prospective, longitudinal design to detect changes in QOL. Three longitudinal studies examined QOL in the acute posttransplantation experience. However, these studies exclusively examined QOL in patients with breast cancer undergoing autologous PBSCT. A fourth study included patients undergoing allogeneic and autologous PBSCT, but did not examine QOL in the acute posttransplantation period.
No studies found in the literature examined QOL in allogeneic and autologous patients during the immediate posttransplantation period. This information is needed to provide a better understanding of the problems experienced by patients during the immediate posttransplantation period so effective interventions can be planned to mitigate them. This information also can be used to identify patients at greater risk for problems so interventions can be initiated as early as possible to increase the likelihood of successful outcomes.
In terms of a source for stem cells, there is increasing evidence that transplanting peripheral blood stem cells rather than stem cells obtained from bone marrow results in accelerated hematopoietic reconstitution. The possible benefits of PBSCT include prompt hematology recovery, shorter hospital stays, and decreased cost. Nonetheless, patients may experience a number of side effects from the marrow ablative therapy and subsequent infusion of autologous or allogeneic peripheral blood stem cells.
Several studies have reported deterioration in physical health status, physical functioning, role functioning, social functioning, and global QOL immediately after the high-dose chemotherapy and PBSCT. In one study, more than 60% of the patients reported a high number of symptoms including fatigue, hair loss, appetite loss, nausea, change in taste, vomiting, fever, and weight loss. Improvement in physical health status has been reported as early as 7 to15 weeks after hospitalization, with most QOL scores returning to the baseline score within 1 year after the treatment. There is, however, conflicting data regarding improvement in physical functioning 1 year after transplantation.
From these studies, a general trend of deterioration in QOL scores after the high-dose chemotherapy followed by improvement can be identified. A more precise trend in terms of length and speed of perceived physical recovery cannot be determined because the method of QOL assessment, time of QOL assessment, and treatment administration differed in each study. Because three of the longitudinal studies focused on patients with breast cancer, these study findings cannot be generalized to males, females with diagnoses other than breast cancer, or allogeneic PBSCT patients. As a result, further study into the trajectory of recovery during the acute posttransplantation period is needed. This prospective, longitudinal study aimed to describe the patient's QOL immediately after the PBSCT, and to describe the trajectory of changes during the transition from hospital to home. The findings from this preliminary study will be used to design a larger multisite study.
The Ferrans' conceptual quality-of-life model was used as a framework to guide the study. Quality of life was assessed in terms of health and functioning, psychological and spiritual, social, economic, and family aspects of life on the basis of domains identified in the model. The model is consistent with the current QOL literature about patients with cancer in that QOL is dynamic, multidimensional, and entails the domains of QOL that generally are recognized in the literature.
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