The symptom experience in the first 100 days following allogeneic hematopoietic stem cell transplantation (HSCT)

Abstract

Goals of work: Despite advances in allogeneic hematopoietic stem cell transplantation (HSCT), post-transplant complications are common, and patients' symptom experience has not been well documented.

Purpose: To characterize the symptom experience of adult patients pre-transplantation and days 0, 30, and 100 after allogeneic HSCT.

Methods: Data from 76 participants enrolled in a prospective health-related quality of life (HRQL) study were used. Symptom occurrence, distress, and clusters were determined based on the 11 symptoms of the Symptom Distress Scale (SDS).

Results: Participants were on average 40 years old (SD +/- 13.5). The majority (54%) received reduced intensity conditioning. Prevalent symptoms included fatigue (68%) and worry (68%) at baseline, appetite change (88%) at day 0, and fatigue at days 30 (90%) and 100 (81%). Participants reported the following symptoms as severely distressing: worry (16%) [baseline], insomnia (32%) [day 0], appetite change (22%) [day 30], and fatigue (11%) [day 100]. The total SDS score was highest at day 0 (M = 26.6 +/- 7.6) when the highest number of symptoms were reported [median = 8 (1-11)]. Symptoms formed clusters comprised of fatigue, appearance change, and worry at baseline, and fatigue, insomnia, and bowel changes at days 0 and 30. Compared to those with low symptom distress, participants with moderate/severe symptom distress reported poorer HRQL.

Conclusion: Allogeneic HSCT patients present for transplantation with low symptom distress yet experience multiple symptoms and high symptom distress after HSCT conditioning. Understanding the symptom experience of allogeneic HSCT patients can guide management strategies and improve HRQL.

Figures

Figure 1

Baseline symptom prevalence and distress Note: n = 74, incomplete survey responses n = 2; Baseline symptom count: Median 5 (range 0-11); Symptom distress (mean±SD) score: 21.2 ± 5.9.

Figure 2

Day 0 symptom prevalence and distress Note: n = 73; Day 0 symptom count: Median 8 (range 1-11); Symptom distress (mean ±SD) score: 26.6 ± 7.6.

Figure 3

Day 30 symptom prevalence and distress Note: n = 67; Day 30 symptom count: Median 7 (range 0-11); Symptom distress (mean ±SD) score: 24.9 ± 7.3.

Figure 4

Day 100 symptom prevalence and distress Note: n = 57; Day 100 symptom count: Median 5 (range 0-11); Symptom distress (mean ±SD) score: 21.6 ± 6.2.

Figure 5

Relationships (rs) Between Symptoms in the Most Prevalent Symptom Clusters at Baseline and Days 0 and 30 after Allogeneic HSCT Note: rs = Spearman Rho Correlation an= 74, bn = 73, cn = 67