Rates and Risk Factors for Post-Traumatic Stress Disorder Symptomatology among Adult Hematopoietic Cell Transplant Recipients and Their Informal Caregivers

Jessica Liang, Stephanie J Lee, Barry E Storer, Bronwen E Shaw, Eric J Chow, Mary E Flowers, Elizabeth F Krakow, Merav Bar, Karen L Syrjala, Rachel B Salit, Chareeni E Kurukulasuriya, Heather S L Jim, Jessica Liang, Stephanie J Lee, Barry E Storer, Bronwen E Shaw, Eric J Chow, Mary E Flowers, Elizabeth F Krakow, Merav Bar, Karen L Syrjala, Rachel B Salit, Chareeni E Kurukulasuriya, Heather S L Jim

Abstract

Hematopoietic cell transplant (HCT) can cause significant distress in patients and their informal caregivers. Despite advances in reduced-intensity conditioning and supportive care, few recent studies have reported rates of clinically significant post-traumatic stress disorder (PTSD) symptomatology. Goals of the current study were to examine rates of PTSD and distress in patients and caregivers and to identify sociodemographic and clinical risk factors for PTSD. As part of an annual survivorship survey, 2157 HCT recipients and their caregivers were mailed self-report measures of PTSD and distress. Patients also completed self-report measures of sociodemographic information (eg, age, sex, employment status). Clinical variables (eg, time since transplant, transplant type) were captured in the transplant database. A total of 691 recipients (56% age 60 or above at the time of survey, 47% women, median 10.1 years post-HCT) and 333 caregivers provided PTSD data and were included in the current analyses. More caregivers reported PTSD (6.6%) than patients (3.3%; P = .02). Patients or caregivers who had PTSD reported significantly higher distress related to uncertainty, family strain, medical demands, finances, identity, and health burden (P < .0001) compared with those without PTSD. Patient but not caregiver PTSD was associated with more recent transplant (P = .01 and P = .16, respectively). Rates of PTSD are relatively low in long-term survivors of HCT and their caregivers. Nevertheless, results are consistent with other studies of cancer caregiving suggesting that caregivers often experience greater distress than patients. Timely referral to psychosocial services should be offered to both HCT recipients and caregivers reporting symptoms of PTSD.

Keywords: Hematopoietic stem cell transplantation; Neoplasms; Post-traumatic stress disorder.

Conflict of interest statement

Disclosure

The authors have no conflicts to disclose.

Copyright © 2018. Published by Elsevier Inc.

References

    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM5)Arlington, VA: American Psychiatric Publishing, 2013.
    1. Kangas M DSM-5 Trauma and Stress-Related Disorders: Implications for Screening for Cancer-Related Stress. Front Psychiatry 2013;4: 122.
    1. El-Jawahri AR, Vandusen HB, Traeger LN, et al. Quality of life and mood predict posttraumatic stress disorder after hematopoietic stem cell transplantation. Cancer 2016;122: 806–812.
    1. Esser P, Kuba K, Scherwath A, et al. Posttraumatic stress disorder symptomatology in the course of allogeneic HSCT: a prospective study. J Cancer Surviv 2017;11: 203–210.
    1. Lee SJ, Loberiza FR, Antin JH, et al. Routine screening for psychosocial distress following hematopoietic stem cell transplantation. Bone Marrow Transplant 2005;35: 77–83.
    1. DuHamel KN, Ostrof J, Ashman T, et al. Construct validity of the posttraumatic stress disorder checklist in cancer survivors: analyses based on two samples. Psychol Assess 2004;16: 255–266.
    1. DuHamel KN, Smith MY, Vickberg SMJ, et al. Trauma Symptoms in Bone Marrow Transplant Survivors: The Role of Nonmedical Life Events. Journal of Traumatic Stress 2001;14: 95–113.
    1. Smith MY, Redd W, DuHamel K, Vickberg SJ, Ricketts P. Validation of the PTSD Checklist-Civilian Version in survivors of bone marrow transplantation. J Trauma Stress 1999;12: 485–499.
    1. Smith SK, Zimmerman S, Williams CS, Preisser JS, Clipp EC. Post-traumatic stress outcomes in non-Hodgkin’s lymphoma survivors. J Clin Oncol 2008;26: 934–941.
    1. Smith SK, Zimmerman S, Williams CS, et al. Post-traumatic stress symptoms in long-term non-Hodgkin’s lymphoma survivors: does time heal? J Clin Oncol 2011;29: 4526–4533.
    1. Jacobsen PB, Sadler IJ, Booth-Jones M, Soety E, Weitzner MA, Fields KK. Predictors of posttraumatic stress disorder symptomatology following bone marrow transplantation for cancer. J Consult Clin Psychol 2002;70: 235–240.
    1. Widows MR, Jacobsen PB, Fields KK. Relation of psychological vulnerability factors to posttraumatic stress disorder symptomatology in bone marrow transplant recipients. Psychosom Med 2000;62: 873–882.
    1. Kuba K, Esser P, Scherwath A, et al. Cancer - and-treatment-specific distress and its impact on posttraumatic stress in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Psychooncology 2017;26: 1164–1171.
    1. Jia M, Li J, Chen C, Cao F. Post-traumatic stress disorder symptoms in family caregivers of adult patients with acute leukemia from a dyadic perspective. Psychooncology 2015;24: 1754–1760.
    1. Simoneau TL, Mikulich-Gilbertson SK, Natvig C, et al. Elevated peri-transplant distress in caregivers of allogeneic blood or marrow transplant patients. Psychooncology 2013;22: 2064–2070.
    1. Bishop MM, Beaumont JL, Hahn EA, et al. Late effects of cancer and hematopoietic stem-cell transplantation on spouses or partners compared with survivors and survivor-matched controls. J Clin Oncol 2007;25: 1403–1411.
    1. Bishop MM, Curbow BA, Springer SH, Lee JA, Wingard JR. Comparison of lasting life changes after cancer and BMT: perspectives of long-term survivors and spouses. Psychooncology 2011;20: 926–934.
    1. Braun M, Mikulincer M, Rydall A, Walsh A, Rodin G. Hidden morbidity in cancer: spouse caregivers. J Clin Oncol 2007;25: 4829–4834.
    1. Janda M, Steginga S, Langbecker D, Dunn J, Walker D, Eakin E. Quality of life among patients with a brain tumor and their carers. Journal of psychosomatic research 2007;63: 617–623.
    1. Grunfeld E, Coyle D, Whelan T, et al. Family caregiver burden: results of a longitudinal study of breast cancer patients and their principal caregivers. CMAJ 2004;170: 1795–1801.
    1. Matthews BA. Role and gender differences in cancer-related distress: a comparison of survivor and caregiver self-reports. Oncol Nurs Forum 2003;30: 493–499.
    1. Ingerski LM, Shaw K, Gray WN, Janicke DM. A pilot study comparing traumatic stress symptoms by child and parent report across pediatric chronic illness groups. J Dev Behav Pediatr 2010;31: 713–719.
    1. Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation. J Trauma Stress 2015;28: 489–498.
    1. Syrjala KL, Chapko ME. Evidence for a biopsychosocial model of cancer treatment-related pain. Pain 1995;61: 69–79.
    1. Syrjala KL, Sutton SK, Jim HS, et al. Cancer and treatment distress psychometric evaluation over time: A BMT CTN 0902 secondary analysis. Cancer 2017;123: 1416–1423.
    1. DuHamel KN, Mosher CE, Winkel G, et al. Randomized clinical trial of telephone-administered cognitive-behavioral therapy to reduce post-traumatic stress disorder and distress symptoms after hematopoietic stem-cell transplantation. J Clin Oncol 2010;28: 3754–3761.
    1. Pillay B, Lee SJ, Katona L, De Bono S, Burney S, Avery S. Factors associated with post-traumatic stress symptoms experienced in the acute phase following haemopoietic stem cell transplant. Bone Marrow Transplant 2016;51: 435–437.
    1. van Beusekom I, Bakhshi-Raiez F, de Keizer NF, Dongelmans DA, van der Schaaf M. Reported burden on informal caregivers of ICU survivors: a literature review. Crit Care 2016;20: 16.
    1. Stukas AA Jr., Dew MA, Switzer GE, DiMartini A, Kormos RL, Griffith BP. PTSD in heart transplant recipients and their primary family caregivers. Psychosomatics 1999;40: 212–221.
    1. National Center for PTSD. Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) Available from URL: [accessed April 17, 2018].
    1. Mosher CE, DuHamel KN, Rini CM, et al. Barriers to mental health service use among hematopoietic SCT survivors. Bone Marrow Transplant 2010;45: 570–579.

Source: PubMed

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