Factors Influencing Health Related Quality of Life in Adult Survivors of Haematopoietic Stem Cell Transplantation

Hyunjin Kwon; Eunjung Ryu

doi:10.5388/aon.2017.17.4.220

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Kwon and Ryu: Factors Influencing Health Related Quality of Life in Adult Survivors of Haematopoietic Stem Cell Transplantation

Original Article

Asian Oncol Nurs 2017;17(4):220-228.

Published online: 5 December 2017

DOI: https://doi.org/10.5388/aon.2017.17.4.220

Factors Influencing Health Related Quality of Life in Adult Survivors of Haematopoietic Stem Cell Transplantation

Hyunjin Kwon¹, Eunjung Ryu²

¹Bone Marrow Translate Center, National Cancer Center, Goyang-si, and Graduate School, Chung-Ang University, Seoul, Korea

²Department of Nursing, Chung-Ang University, Seoul, Korea

^∗ This article is based on a part of the first author's master's thesis from Chung-Ang University.

Address reprint requests to: Ryu, Eunjung Department of Nursing, Chung-Ang University 84 Heuksuk-ro, Dongjak-gu, Seoul 06974, Korea. Tel: +82-2-820-5681 Fax: +82-2-824-7961 E-mail: go2ryu@cau.ac.kr

Received 22 Apr 201719 Dec 2017 Accepted 27 Dec 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose

The aim of the study is to evaluate the health-related quality of life, psychological symptoms, distress, and sense of coherence in adult haematopoietic stem cell transplantation survivors.

Methods

Fifty two survivors completed four questionnaires after the transplantation. The questionnaires were the Functional Assessment of Cancer Therapy-BMT Scale, the National Cancer Center Psychological Symptom Inventory, the Distress Thermometer, and the Sense of Coherence scale.

Results

Quality of life was positively correlated with sense of coherence, whereas sense of coherence was negatively correlated with all psychological symptoms and distress. Hierarchical regression analyses revealed that sense of coherence was the only significant predictor of quality of life after controlling for sex and age at transplantation. Model 2 explained 33.2% of the total variance of quality of life

Conclusion

Supporting patients towards improving comprehensibility, manageability and meaningfulness, the three components of sense of coherence, may be benefi-cial and improve outcomes. Individually pre-transplant and post-transplant assessments of sense of coherence may be of clinical importance, in order to identify patients with unmet needs and to provide prolonged support.

Keywords: Hematopoietic Stem Cell Transplantation, Quality of Life, Symptom Assessment, Distress, Sense of Coherence

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Table 1.

The Sample's Characteristics and Differences on FACT-BMT (N =52)

Variables	Characteristics	n (%) or M ± SD	M ± SD	t or F	p
Gender	Male	31 (59.6)	74.70 ± 9.95	2.51	.015
Gender	Female	21 (40.4)	67.67 ± 9.76
Age (year)		49.8 ± 12.68
Religion	Christianity	17 (32.7)	72.15 ^± 11.63	0.31	.816
	Buddhist	9 (17.3)	72.39 ± 11.68
	Catholic	10 (19.2)	69.02 ± 8.09
	Others	16 (30.8)	73.02 ± 10.15
Education	Elementary school ^a	6 (11.5)	60.33 ± 6.72	4.90	.005
	Middle school ^b	4 (7.7)	67.04 ± 4.00		(a＜ d)
	High school ^c	23 (44.2)	71.91 ± 10.94
	College/University ^d	19 (36.6)	76.45 ± 8.49
Marital status	Single/divorced	38 (73.0)	69.49 ± 12.16	-0.99	.322
Marital status	Married/cohabiting	14 (27.0)	72.73 ± 9.68
Monthly income (10,000 won)	≤100	7 (13.5)	66.38 ± 8.78	0.65	.626
	100~200	11 (21.2)	71.56 ± 9.47
	200~300	15 (28.8)	72.06 ± 12.47
	300~400	8 (15.4)	73.81 ± 7.67
	≥400	11 (21.1)	73.95 ± 11.20
Age at transplantation (year)		48.7 ± 12.75
Pre-transplant diagnoses	Acute myeloid leukaemia	11 (21.1)	74.64 ± 10.77	0.27	.894
	Acute lymphoblastic leukaemia	4 (7.7)	72.88 ± 9.42
	Multiple Myeloma	20 (38.5)	70.70 ^± 11.36
	myelodysplastic syndrome	5 (9.6)	71.63 ± 10.69
	Lymphoma	12 (23.1)	71.00 ± 9.71
Type of HSCT	Allogeneic	20 (38.5)	73.53 ± 10.04	0.91	.363
Type of HSCT	Autologous	32 (61.5)	70.81 ± 10.61
Time since diagnosis (month)	≤12	13 (25.0)	73.73 ^± 9.39	0.74	.458
Time since diagnosis (month)	＞12	39 (75.0)	71.24 ± 10.73
Time since HSCT (month)	＜6	14 (27.0)	75.17 ± 9.32	2.90	.064
	6~12	19 (36.5)	67.51 ± 10.33
	≥12	19 (36.5)	73.77 ± 10.18
Reason of readmission∗	GVHD	5 (14.7)
	Recurrence	2 (5.9)
	Infection	8 (23.5)
	Fever	3 (8.8)
	Other	16 (47.1)

HSCT= Hematopoietic stem cell transplantation; GVHD= Graft versus host disease;

^∗ Multiple response.

Table 2.

Descriptive Statistics for Study Variables (N =52)

Variables	M ± SD	Minimum	Maximum	Range
Psychological symptom
Insomnia severity	3.44 ± 2.45	0	8	8
Insomnia impact	2.46 ± 2.28	0	8	8
Insomnia SIT	5.90 ± 3.88	0	15	15
Anxiety severity	2.13 ± 2.42	0	9	9
Anxiety impact	2.60 ± 2.08	0	8	8
Anxiety SIT	4.73 ± 3.74	0	15	15
Depression severity	1.98 ± 1.69	0	6	6
Depression impact	2.02 ± 1.91	0	7	7
Depression SIT	4.00 ± 3.20	0	10	10
Distress	3.44 ± 2.45	0	8	8
Sense of coherence	66.86 ± 10.55	47	89	42
Health-related quality of life
Physical Well-being	7.88 ± 5.63	0	22	22
Social Well-being	17.32 ± 5.39	4	28	25
Emotional Well-being	7.79 ± 3.27	3	16	13
Functional Well-being	17.13 ± 6.49	5	28	23
BMTS	21.73 ± 5.85	10	38	28
FACT-G	50.13 ± 8.12	35	65	30
FACT-BMT	71.86 ± 10.38	53	96	43

SIT= Severity and impact total score; BMTS= Bone marrow transplant subscale; FACT-G= Functional assessment of cancer therapy – general; FACT-BMT= Functional assessment of cancer therapy – bone marrow transplant.

Table 3.

Group Classification between SIT Cutoff Score and Intention to Request Help in the NCC-PSI (N =28)

Group	SIT cutoff score	Insomnia (n=14)	Anxiety (n=8)	Depression (n=6)	Total
Insomnia	≥10	4	0	3	7
Insomnia	≤9	10	8	3	21
Anxiety	≥9	6	1	1	8
Anxiety	≤8	8	7	5	20
Depression	≥10	2	1	2	5
Depression	≤9	12	7	4	23

NCC-PSI= National cancer center psychological symptom inventory; SIT= Severity and impact total score; *28 participants checked the item, ‘symptoms for which you wish to get help for from the health care professionals’.

Table 4.

Correlation Analysis for Study Variables

Variables	1	2	3	4	5	6	7	8	9
Variables	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)	r (p)
1. Insomnia severity	1.00
2. Insomnia impact	.34 (.014)	1.00
3. Anxiety severity	.27 (.047)	.70 (＜.001)	1.00
4. Anxiety impact	.46 (.001)	.39 (.004)	.37	1.00 (.006)
5. Depression severity	.426 (.002)	.50 (＜.001)	.70 (＜.001)	.76 (＜.001)	1.00
6. Depression impact	.60 (＜.001)	.30 (.027)	.35 (.010)	.39 (.010)	.57 (＜.001)	1.00
7. Distress	1.00 (＜.001)	.34 (.014)	.27 (.047)	.46 (.001)	.42 (.002)	.60 (＜.001)	1.00
8. Sense of coherence	-.38 (.005)	-.36 (.009)	-.40 (.003)	-.63 (＜.001)	-.66 (＜.001)	-.50 (＜.001)	-.38 (.005)	1.00
9. Health-related quality of life	-.20 (.154)	-.06 (.63)	-.06 (.67)	-.17 (.226)	-.15 (.286)	-.23 (.08)	-.200 (.154)	.37 (.007)	1.00

Values are presented as r (p), unless otherwise indicated.

Table 5.

The Predictors of Health-related Quality of Life in HSCT Survivors

Variables	Model 1				Model 2
Variables	B	SE	t	p	B	SE	t	p
(Constant)	82.23	5.16	15.91	＜.001	60.43	10.53	5.73	＜.001
Gender (female=0)	7.06	2.58	2.73	.009	6.75	2.46	2.73	＜.001
Age at transplantation	-0.30	0.10	-3.05	.004	-0.33	0.09	-3.53	.001
Insomnia severity					4.92	4.89	1.00	.321
Anxiety severity					0.78	3.51	0.22	.824
Depression severity					-3.42	4.71	-0.72	.471
Distress					-0.71	0.96	-0.73	.465
Sense of coherence					0.37	0.13	2.71	.010
F (df) Adjusted R²	F_(2, ₄₈₎=7.94 (.001) 7.94, p=.001				F_(7, ₄₃₎=4.54 (.001) 4.54, p=.001

HSCT= Hematopoietic stem cell transplantation; SE= Standard error.

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