Many patients develop clinically significant PTSD symptoms early after HSCT
Nearly one-fifth of patients who undergo hematopoietic stem cell transplantation develop symptoms of PTSD within 6 months, according to study results presented during the ASCO20 Virtual Scientific Program.
The researchers also identified risk factors associated with developing PTSD symptoms in this patient population.
Previous studies have evaluated PTSD among patients who undergo HSCT, but none has examined rates within the first 6 months, according to Areej El-Jawahri, MD, director of the BMT Survivorship Program at Massachusetts General Hospital.
“Patients undergoing stem cell transplantation experience a difficult and socially isolating hospitalization,” she told Healio.
“Studies that specifically provide information on the most common PTSD symptoms in this population are lacking,” she added. “We wanted to get a better sense of which patients would be at high risk [for] developing clinically significant PTSD symptoms, and we were specifically interested in identifying risk factors for PTSD.”
The researchers performed a secondary analysis of longitudinal data on 250 adults (mean age, 56.3 ± 13.3 years; 48.8% men; 88% white) who underwent autologous (44%) or allogeneic (56%) HSCT for a hematologic malignancy at Massachusetts General Hospital between August 2014 and January 2016.
Study objectives included assessment of clinically significant symptoms of PTSD among patients who underwent HSCT, identifying the prominent symptoms of PTSD among these patients 6 months after HSCT and determining risk factors associated with PTSD symptoms among HSCT survivors.
The investigators used the Post-Traumatic Stress Checklist (PTSD-CL) to evaluate PTSD symptoms 6 months after transplantation.
They evaluated quality of life at baseline, 2 weeks and 6 months using the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) scale, and depression and anxiety symptoms using the Hospital Anxiety and Depression Scale.
Linear regression models enabled researchers to examine the association between baseline factors and PTSD symptoms 6 months after HSCT. Separate multivariate regression models were used to evaluate quality of life, depression and anxiety.
The statistical analysis showed nearly one-fifth (18.9%) of patients had clinically significant PTSD symptoms 6 months after HSCT. The most common symptoms were hypervigilance (92.3%), avoidance (92.3%) and intrusion (76.9%).
Being single (B = 3.35, P = .027) and having a lower quality of life at baseline (B = 0.04, P = .004) appeared associated with a higher likelihood of PTSD symptoms 6 months after HSCT.
Higher anxiety at baseline (B = 1.34; 95% CI, 0.92-1.76), a change in anxiety during hospitalization (B = 0.59; 95% CI, 0.17-1.01) and being single (B = 3.5; 95% CI, 6.37 to 0.64) appeared associated with higher risk for PTSD symptoms 6 months after HSCT.
A separate model showed younger age (B = 0.13; 95% CI, 0.23 to 0.02), being single (B = 3.58; 95% CI, 6.54 to 0.62) and higher baseline depression symptoms (B = 0.97; 95% CI, 0.57-1.37) were associated with higher PTSD symptoms at 6 months.
“Clinically significant PTSD symptoms are common among transplant recipients at 6 months posttransplant,” El-Jawahri told Healio. “We also learned that baseline factors prior to transplant, such as quality of life, psychological distress and social support, may identify patients at risk for developing worse PTSD symptoms.
“Unfortunately, psychiatric and mental health care are not part of standard of care for transplant recipients,” El-Jawahri said. “This work highlights the need for better integration of mental health care providers in the care of transplant recipients.”
The results should have some impact on posttransplant clinical care, according to El-Jawahri.
“I think these data suggest that we should be screening for PTSD symptoms in transplant recipients to identify those who may benefit from additional help and support after transplant,” she concluded.