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Quality of Life

Psychosocial adjustment and quality of life among multiple myeloma patients undergoing evaluation for autologous stem cell transplantation

Summary:

Stem cell transplantation has assumed a prominent place in the treatment of multiple myeloma, but relative to patients with other malignancies there is surprisingly little information about the adjustment difficulties and quality-of-life changes that these patients experience. This study examined psychosocial and functional deficits among myeloma patients assessed at a uniform period during their initial diagnostic evaluation, prior to beginning protocols at a transplant center. Validated self-report measures and clinician rating scales were used to assess 213 patients. Outcomes evaluated included emotional distress (Hospital Anxiety and Depression Scale, Brief Symptom Inventory), depression (Hamilton Depression Rating Scale), physical functioning, pain, and energy (SF-12). A significant proportion of patients experienced compromised psychosocial and physical functioning. Roughly one-third reported clinically elevated levels of distress, anxiety, and depression. In all, 59% scored below age-adjusted norms for daily physical functioning, 58% reported at least moderate levels of pain, and over 80% noted at least moderate fatigue. Clinical and demographic correlates of these outcomes were examined. These findings are among the first to characterize quality-of-life outcomes among myeloma patients in the transplant setting, and indicate that many patients experience considerable supportive care needs even prior to beginning aggressive regimens. Results highlight the importance of early screening.

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References

  1. Bataille R, Harousseau JL . Multiple myeloma. N Engl J Med 1997; 336: 1657–1664.

    Article  CAS  PubMed  Google Scholar 

  2. Jenal A, Thomas A, Murray T, Thun M . Cancer statistics, 2002. CA Cancer J Clin 2002; 52: 23–47.

    Article  Google Scholar 

  3. Pandit S, Vesole DH . Multiple myeloma: role of allogeneic transplantation. Oncology 2002; 16: 1268–1274.

    PubMed  Google Scholar 

  4. Barlogie B, Shaughnessy J, Tricot G et al. Treatment of multiple myeloma. Blood 2004; 103: 20–32.

    Article  CAS  PubMed  Google Scholar 

  5. Rajkumar SV, Witzig TE . A review of angiogenesis and antiangiogenic therapy with thalidomide in multiple myeloma. Cancer Treatment Rev 2000; 26: 351–362.

    Article  CAS  Google Scholar 

  6. Attal M, Harousseau JL, Stoppa AM et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Francais du Myelome. N Engl J Med 1996; 335: 91–97.

    Article  CAS  PubMed  Google Scholar 

  7. Child J, Morgan G, Davies F et al. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 2003; 348: 1875–1883.

    Article  CAS  PubMed  Google Scholar 

  8. Barlogie B, Jagannath S, Vesole DH et al. Superiority of tandem autologous transplantation over standard therapy for previously untreated multiple myeloma. Blood 1997; 89: 789–793.

    CAS  PubMed  Google Scholar 

  9. Lenhoff S, Hjorth M, Holmberg E et al. Impact on survival of high-dose therapy with autologous stem cell support in patients younger than 60 years with newly diagnosed multiple myeloma: a population-based study. Nordic Myeloma Study Group. Blood 2000; 95: 7–11.

    CAS  PubMed  Google Scholar 

  10. Attal M, Harousseau JL, Facon T et al. Double autologous transplantation improves survival of multiple myeloma patients: final analysis of a prospective randomized study of the ‘Integroupe Francophone du Myelome’ (IFM 94). Blood 2002; 100: 7a (Abstr.).

    Google Scholar 

  11. Barlogie B, Jagannath S, Desikan KR et al. Total therapy with tandem transplants for newly diagnosed multiple myeloma. Blood 1999; 93: 55–65.

    CAS  PubMed  Google Scholar 

  12. Fermand JP, Ravaud P, Chevret S et al. Early versus late high dose therapy (HTD) and autologous peripheral blood stem cell transplantation in multiple myeloma (MM): results of a prospective randomized trial. Blood 1996; 88 (Suppl. 1): 685a.

    Google Scholar 

  13. Barlogie B . High-dose therapy and innovative approaches to treatment of multiple myeloma. Semin Hematol 2001; 38 (Suppl. 3): 21–27.

    Article  CAS  PubMed  Google Scholar 

  14. Andrykowski MA, Altmaier EM, Barnett RL et al. The quality of life in adult survivors of allogeneic bone marrow transplantation. Transplantation 1990; 50: 399–406.

    Article  CAS  PubMed  Google Scholar 

  15. Bush NE, Haberman M, Donaldson G et al. Quality of life of 125 adults surviving 6–18 years after bone marrow transplantation. Soc Sci Med 1995; 40: 479–490.

    Article  CAS  PubMed  Google Scholar 

  16. Chiodi S, Spinelli S, Ravera G et al. Quality of life in 244 recipients of allogeneic bone marrow transplantation. Br J Haematol 2000; 110: 614–619.

    Article  CAS  PubMed  Google Scholar 

  17. Syrjala KL, Chapko MK, Vitaliano PP et al. Recovery after allogeneic transplantation: prospective study of predictors of long-term physical and psychosocial functioning. Bone Marrow Transplant 1993; 11: 319–327.

    CAS  PubMed  Google Scholar 

  18. Siston AK, List MA, Daugherty CK et al. Psychosocial adjustment of patients and caregivers prior to allogeneic bone marrow transplantation. Bone Marrow Transplant 2001; 27: 1181–1188.

    Article  CAS  PubMed  Google Scholar 

  19. Chao NJ, Tierney K, Bloom JR et al. Dynamic assessment of quality of life after autologous bone marrow transplantation. Blood 1992; 80: 825–830.

    CAS  PubMed  Google Scholar 

  20. Andrykowski MA, Cordova MJ, Hann DM et al. Patients’ psychosocial concerns following stem cell transplantation. Bone Marrow Transplant 1999; 24: 1121–1129.

    Article  CAS  PubMed  Google Scholar 

  21. Molassiotis A, van den Akker OBA, Boughton BJ . Perceived social support, family environment and psychosocial recovery in bone marrow transplant long-term survivors. Soc Sci Med 1997; 44: 317–325.

    Article  CAS  PubMed  Google Scholar 

  22. Molassiotis A, van den Akker OBA, Milligan DW et al. Quality of life in long-term survivors of marrow transplantation: comparison with a matched group receiving maintenance chemotherapy. Bone Marrow Transplant 1996; 17: 249–258.

    CAS  PubMed  Google Scholar 

  23. Winer EP, Lindley C, Hardee M et al. Quality of life in patients surviving at least 12 months following high dose chemotherapy with autologous bone marrow support. Psycho-Oncology 1999; 8: 1167–1176.

    Article  Google Scholar 

  24. Sherman AC, Coleman EA, Griffith K et al. Use of a supportive care team for screening and preemptive intervention among multiple myeloma patients receiving stem cell transplantation. Support Care Cancer 2003; 11: 568–574.

    Article  PubMed  Google Scholar 

  25. Langer S, Abrams J, Syrjala K . Caregiver and patient marital satisfaction and affect following hematopoietic stem cell transplantation: a prospective, longitudinal investigation. Psycho-Oncology 2003; 12: 239–253.

    Article  PubMed  Google Scholar 

  26. Grassi L, Rosti G, Albertazzi L et al. Psychological stress symptoms before and after autologous bone marrow transplantation in patients with solid tumors. Bone Marrow Transplant 1996; 17: 843–847.

    CAS  PubMed  Google Scholar 

  27. Hjermstad MJ, Loge JH, Evensen SA et al. The course of anxiety and depression during the first year after allogeneic or autologous stem cell transplantation. Bone Marrow Transplant 1999; 24: 1219–1228.

    Article  CAS  PubMed  Google Scholar 

  28. McQuellon RP, Russell GB, Rambo TD et al. Quality of life and psychological distress of bone marrow transplant recipients: the ‘time trajectory’ to recovery over the first year. Bone Marrow Transplant 1998; 21: 477–486.

    Article  CAS  PubMed  Google Scholar 

  29. Wettergren L, Langius A, Bjorkholm M et al. Physical and psychosocial functioning in patients undergoing autologous bone marrow transplantation – a prospective study. Bone Marrow Transplant 1997; 20: 497–502.

    Article  CAS  PubMed  Google Scholar 

  30. Jenkins PL, Lester H, Alexander J et al. A prospective study of psychosocial morbidity in adult bone marrow transplant recipients. Psychosomatics 1994; 335: 361–367.

    Article  Google Scholar 

  31. Keogh F, O'Riordan J, McNamara C et al. Psychosocial adaptation of patients and families following bone marrow transplantation: a prospective, longitudinal study. Bone Marrow Transplant 1998; 22: 905–911.

    Article  CAS  PubMed  Google Scholar 

  32. Leigh S, Wilson KCM, Burns R et al. Psychosocial morbidity in bone marrow transplant recipients: a prospective study. Bone Marrow Transplant 1995; 16: 635–640.

    CAS  PubMed  Google Scholar 

  33. Meyers CA, Weitzner M, Byrne K et al. Evaluation of the neurobehavioral functioning of patients before, during, and after bone marrow transplantation. J Clin Oncol 1994; 12: 820–826.

    Article  CAS  PubMed  Google Scholar 

  34. Hjermstad MJ, Evensen SA, Kvaloy SO et al. Health-related quality of life 1 year after allogeneic or autologous stem-cell transplantation: a prospective study. J Clin Oncol 1999; 17: 706–718.

    Article  CAS  PubMed  Google Scholar 

  35. McQuellon RP, Craven B, Russell GB et al. Quality of life in breast cancer patients before and after autologous bone marrow transplantation. Bone Marrow Transplant 1996; 18: 579–584.

    CAS  PubMed  Google Scholar 

  36. Wisloff F, Hjorth M, Kaasa S, Westin J . Effect of interferon on the health-related quality of life of multiple myeloma patients: results of a Nordic randomized trial comparing melphalan–prednisone to melphalan–prednisone+alpha-interferon. Br J Hematol 1996; 94: 324–332.

    Article  CAS  Google Scholar 

  37. Wisloff F, Hjorth M . Health-related quality of life assessed before and during chemotherapy predicts for survival in multiple myeloma. Br J Hematol 1997; 97: 29–37.

    Article  CAS  Google Scholar 

  38. Silberfarb PM, Andererson KM, Rundle AC et al. Mood and clinical status in patients with multiple myeloma. J Clin Oncol 1991; 9: 2219–2224.

    Article  CAS  PubMed  Google Scholar 

  39. Poulos AR, Gertz MA, Pankratz VS, Post-White J . Pain, mood disturbance, and quality of life in patients with multiple myeloma. Oncol Nurs Forum 2001; 28: 1163–1171.

    CAS  PubMed  Google Scholar 

  40. Berenson JR, Lichtenstein A, Porter L et al. Efficacy of pamidronate in reducing skeletal events in patients with advanced multiple myeloma. Myeloma Aredia Study Group. N Engl J Med 1996; 334: 488–493.

    CAS  Google Scholar 

  41. Passik SD, Dugan W, McDonald MV et al. Oncologists’ recognition of depression in their patients with cancer. J Clin Oncol 1998; 16: 1594–1600.

    Article  CAS  PubMed  Google Scholar 

  42. Ware JE . SF-12 Health Survey: Manual and Interpretation guide. The Health Institute, New England Medical Center: Boston, MA, 1995.

    Google Scholar 

  43. Marks DI, Gale DJ, Vedhara K et al. A quality of life study in 20 adult long-term survivors of unrelated donor bone marrow transplantation. Bone Marrow Transplant 1999; 24: 191–195.

    Article  CAS  PubMed  Google Scholar 

  44. Zigmond AS, Snaith RP . Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67: 361–370.

    Article  CAS  PubMed  Google Scholar 

  45. Razavi D, Delvaux N, Farvacques C et al. Screening for adjustment disorders and major depressive disorders in cancer in-patients. Br J Psychiatry 1990; 156: 79–83.

    Article  CAS  PubMed  Google Scholar 

  46. Bjelland I, Dahl AA, Haug TT et al. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res 2002; 52: 69–77.

    Article  PubMed  Google Scholar 

  47. Derogatis LR . Brief Symptom Inventory: Administration, Scoring, and Procedures Manual. National Computer Systems, Inc.: Minneapolis, MN, 1993.

    Google Scholar 

  48. Hamilton M . Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967; 6: 278–296.

    Article  CAS  PubMed  Google Scholar 

  49. Fleck MPA, Poirier-Littre MF, Guelfi J-D et al. Factorial structure of the 17-item Hamilton Depression Rating Scale. Acta Psychiatr Scand 1995; 92: 168–172.

    Article  CAS  PubMed  Google Scholar 

  50. Onega LL, Abraham IL . Factor structure of the Hamilton Rating Scale for Depression in a cohort of community-dwelling elderly. Int J Geriat Psychiatry 1997; 12: 760–764.

    Article  CAS  Google Scholar 

  51. Winer BJ . Statistical Principles in Experimental Design. McGraw-Hill: New York, 1971.

    Google Scholar 

  52. Hammond MF . Rating depression severity in the elderly physically ill patient: reliability and factor structure of the Hamilton and the Montegomery-Asberg Depression Rating Scales. Int J Geriat Psychiatry 1998; 13: 257–261.

    Article  CAS  Google Scholar 

  53. Silverstone PH . Measuring depression in the physically ill. Int J Methods Psychiat Res 1991; 1: 3–12.

    Google Scholar 

  54. World Health Organization. Cancer pain relief and palliative care: report of a WHO expert committee, WHO: Geneva, Switzerland, Technical report series, 0 12-30 4:804 1990.

  55. Portenoy RK, Payne D, Jacobsen P . Breakthrough pain: characteristics and impact in patients with cancer pain. Pain 1999; 81: 129–134.

    Article  CAS  PubMed  Google Scholar 

  56. Hann DM, Jacobsen PB, Martin SC et al. Quality of life following bone marrow transplantation for breast cancer: a comparative study. Bone Marrow Transplant 1997; 19: 257–264.

    Article  CAS  PubMed  Google Scholar 

  57. Fife BL, Huster GA, Cornetta KG et al. Longitudinal study of adaptation to the stress of bone marrow transplantation. J Clin Oncol 2000; 18: 1539–1549.

    Article  CAS  PubMed  Google Scholar 

  58. Carver CS, Pozo-Kaderman C, Harris SD et al. Optimism versus pessimism predicts the quality of women's adjustment to early stage breast cancer. Cancer 1994; 73: 1213–1220.

    Article  CAS  PubMed  Google Scholar 

  59. Lepore SJ, Silver RC, Wortman CB et al. Social constraints, intrusive thoughts, and depressive symptoms among bereaved mothers. J Pers Soc Psychol 1996; 70: 271–283.

    Article  CAS  PubMed  Google Scholar 

  60. Sherman AC, Simonton S, Plante T et al. Patterns of religious coping among multiple myeloma patients: associations with adjustment and quality of life. Psychosom Med 2001; 63: 124 (Abstr.).

    Google Scholar 

  61. Sherman AC, Plante T, Simonton S et al. Associations between religious/existential resources and quality of life outcomes for multiple myeloma patients. Psychosom Med 2001; 63: 128 (Abstr.).

    Google Scholar 

  62. Antoni MH, Lehman JM, Kilbourn KM et al. Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit-finding among women under treatment for early-stage breast cancer. Health Psychol 2001; 20: 20–32.

    Article  CAS  PubMed  Google Scholar 

  63. Bishop MM . Quality of life and relationships after BMT: preliminary results, Presented at the 2002 Tandem BMT Meetings of the International Bone Marrow Transplant Registry, Autologous Blood and Marrow Transplant Registry, and American Society of Blood and Marrow Transplantation, Orlando, FL, February, 23 2002.

  64. Durie BGM, Salmon SE . A clinical staging system for multiple myeloma: correlates of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer 1975; 36: 842–854.

    Article  CAS  PubMed  Google Scholar 

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Sherman, A., Simonton, S., Latif, U. et al. Psychosocial adjustment and quality of life among multiple myeloma patients undergoing evaluation for autologous stem cell transplantation. Bone Marrow Transplant 33, 955–962 (2004). https://doi.org/10.1038/sj.bmt.1704465

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