Post-Traumatic Stress Symptoms After Hematopoietic Stem Cell Transplantation

Approximately one fifth of hematopoietic stem cell transplant (HCT) recipients may experience clinically significant post-traumatic stress disorder (PTSD) symptoms after transplant, according to the findings presented by Sarah Griffith, BA, of Massachusetts General Hospital in Boston, during the ASCO20 Virtual Scientific Program.

The researchers conducted a secondary analysis of longitudinal data from patients diagnosed with hematologic malignancy who underwent autologous or allogeneic HCT at Massachusetts General Hospital between August 2014 and January 2016. The investigators aimed to assess the prevalence of clinically significant PTSD symptoms, identify the most prominent PTSD symptoms, and identify risk factors associated with PTSD symptoms in HCT survivors.

Patients completed a validated tool for assessing PTSD symptoms, the PTSD Checklist (PTSD-CL), 6 months after HCT. They also completed the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) during the second week of hospitalization and at 6-months post-HCT and the Hospital Anxiety and Depression Scale to assess quality of life (QOL), depression, and anxiety symptoms at the time of admission.

Multivariate regression modeling was used to assess factors associated with PTSD symptoms; due to collinearity, QOL, depression, and anxiety symptoms were modeled separately. Griffith noted that the patients were also participating in 2 supportive care intervention trials; therefore, the present study controlled for the intervention effect in all analyses.

In total, 250 adult patients (mean age (SD), 56.3 years (13.3); 51.2% of patients were male) participated in the study. Most were married or with a partner (71.2%) and had college (48.8%) or graduate school (22.8%) education.

At 6 months post-HCT, 18.9% of patients experienced clinically significant PTSD symptoms. The most common symptoms among these patients were hypervigilance (92.3%), avoidance (92.3%), and intrusion (76.9%). However, even patients who did not meet the criteria for clinically significant PTSD symptoms reported avoidance (24.5%) and hypervigilance (13.7%) symptoms.

The QOL model revealed that lower QOL at the time of admission for HCT (B= -0.04; P =.004) and being single (B= -3.35; P =.027) were associated with higher scores for PTSD symptoms at 6 months.

The depression model revealed that younger age (B= -0.13; P =.017), being single (B= -3.58; P =.018), and higher baseline depression symptoms (B= 0.97; P <.001) were associated with higher scores for PTSD symptoms at 6 months.

The anxiety model revealed that higher anxiety at the time of admission for HCT (B=1.34; P <.001), change in anxiety during hospitalization (B=0.59; P =.006), and being single (B= -3.50; P =.017), were associated with higher scores for PTSD symptoms at 6 months.

Limitations of the trial included that it was a single-site study with a predominantly white patient population (88%), limiting generalizability; the study was not able to assess causality of relationship between baseline factors and symptoms; and diagnostic evaluation was not used to assess for PTSD diagnosis.

“It is very important to be aware of and to manage PTSD symptoms [in patients undergoing HCT],” explained Griffith. “Patients [at risk for developing worse PTSD symptoms] may benefit from tailored supportive care interventions and intervening during the transplantation could be beneficial in preventing PTSD symptoms.”

Reference

Griffith S, Fenech AL, Nelson A, Greer JA, Temel JS, El-Jawahri A. Post-traumatic stress symptoms in hematopoietic stem cell transplant (HCT) recipients. Presented at: ASCO20 Virtual Scientific Program. J Clin Oncol. 2020;38(suppl):abstr 7505.

This article originally appeared on Hematology Advisor