TY - JOUR
T1 - Impact of Psychological Distress on Quality of Life, Functional Status, and Survival in Patients with Chronic Graft-versus-Host Disease
AU - El-Jawahri, Areej
AU - Pidala, Joseph
AU - Khera, Nandita
AU - Wood, William A.
AU - Arora, Mukta
AU - Carpenter, Paul A.
AU - Palmer, Jeanne
AU - Flowers, Mary E.
AU - Jagasia, Madan
AU - Chen, Yi Bin
AU - Lee, Stephanie J.
N1 - Publisher Copyright:
© 2018 American Society for Blood and Marrow Transplantation
PY - 2018/11
Y1 - 2018/11
N2 - Data on psychological distress and its association with clinical outcomes in patients with chronic graft-versus-host-disease (GVHD) are lacking. We used data of patients with chronic GVHD (N = 482) from the Chronic GVHD Consortium, a prospective observational multicenter cohort. We examined the relationship between self-reported depression or anxiety symptoms (measured by the Lee Symptom Scale) and patients’ quality of life (QOL; measured by the Functional Assessment of Cancer Therapy-General [FACT-G] and the Physical Component Scale [PCS] of the 36-item Short-Form Health Survey), physical functioning (measured by the Human Activity Profile), functional status (measured by the 2-minute walk test), and overall survival (OS). Overall, 19.3% of patients (93/481) reported being moderately to extremely bothered by depression, and 22.8% (110/482) reported being moderately to extremely bothered by anxiety, with 14.1% (68/482) of those reporting being bothered by both. In multivariable models adjusted for clinical covariates, patients with self-reported depression had worse QOL (FACT-G: β = –23.09, P <.001; PCS: β = –4.94, P <.001), physical functioning (β = –8.31, P <.001), functional status (β = –37.21, P =.025), and lower OS (hazard ratio, 1.62; P =.020) compared with those with no depression symptoms. Patients who reported anxiety also had lower QOL (FACT-G: β = –19.47, P <.001; PCS: β = –3.91, P <.001), physical functioning (β = –6.69, P <.001), and functional status (β = –32.42, P =.036) but no difference in OS. Patients with chronic GVHD who report depression or anxiety symptoms have significantly compromised QOL and physical functioning. Self-reported depression is associated with lower OS. Patients with chronic GVHD and self-reported depression or anxiety represent a highly vulnerable population at risk for poor clinical outcomes and substantial morbidity from their illness.
AB - Data on psychological distress and its association with clinical outcomes in patients with chronic graft-versus-host-disease (GVHD) are lacking. We used data of patients with chronic GVHD (N = 482) from the Chronic GVHD Consortium, a prospective observational multicenter cohort. We examined the relationship between self-reported depression or anxiety symptoms (measured by the Lee Symptom Scale) and patients’ quality of life (QOL; measured by the Functional Assessment of Cancer Therapy-General [FACT-G] and the Physical Component Scale [PCS] of the 36-item Short-Form Health Survey), physical functioning (measured by the Human Activity Profile), functional status (measured by the 2-minute walk test), and overall survival (OS). Overall, 19.3% of patients (93/481) reported being moderately to extremely bothered by depression, and 22.8% (110/482) reported being moderately to extremely bothered by anxiety, with 14.1% (68/482) of those reporting being bothered by both. In multivariable models adjusted for clinical covariates, patients with self-reported depression had worse QOL (FACT-G: β = –23.09, P <.001; PCS: β = –4.94, P <.001), physical functioning (β = –8.31, P <.001), functional status (β = –37.21, P =.025), and lower OS (hazard ratio, 1.62; P =.020) compared with those with no depression symptoms. Patients who reported anxiety also had lower QOL (FACT-G: β = –19.47, P <.001; PCS: β = –3.91, P <.001), physical functioning (β = –6.69, P <.001), and functional status (β = –32.42, P =.036) but no difference in OS. Patients with chronic GVHD who report depression or anxiety symptoms have significantly compromised QOL and physical functioning. Self-reported depression is associated with lower OS. Patients with chronic GVHD and self-reported depression or anxiety represent a highly vulnerable population at risk for poor clinical outcomes and substantial morbidity from their illness.
KW - Anxiety
KW - Chronic graft-versus-host disease
KW - Depression
KW - Psychological distress
KW - Transplant survivors
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U2 - 10.1016/j.bbmt.2018.07.020
DO - 10.1016/j.bbmt.2018.07.020
M3 - Article
C2 - 30031937
AN - SCOPUS:85052738347
SN - 1083-8791
VL - 24
SP - 2285
EP - 2292
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 11
ER -