Impact of Psychological Distress on Quality of Life, Functional Status, and Survival in Patients with Chronic Graft-versus-Host Disease

Areej El-Jawahri, Joseph Pidala, Nandita Khera, William A. Wood, Mukta Arora, Paul A. Carpenter, Jeanne Palmer, Mary E. Flowers, Madan Jagasia, Yi Bin Chen, Stephanie J. Lee

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2285-2292
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume24
Issue number11
DOIs
StatePublished - Nov 2018

Bibliographical note

Funding Information:
Financial disclosure: Supported by grants CA118953 and CA163438 from the NIH. The Chronic GVHD Consortium (U54 CA163438) is a part of the NIH Rare Diseases Clinical Research Network, supported through collaboration between the NIH office of Rare Diseases Research at the National Center for Advancing Translational Science, the National Cancer Institute, and the Fred Hutchinson Cancer Research Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Also supported by the American Cancer Society Institutional Research Grant (to A.E.-J.)., Conflict of interest statement: There are no conflicts of interest to report.

Funding Information:
Financial disclosure: Supported by grants CA118953 and CA163438 from the NIH. The Chronic GVHD Consortium (U54 CA163438) is a part of the NIH Rare Diseases Clinical Research Network, supported through collaboration between the NIH office of Rare Diseases Research at the National Center for Advancing Translational Science, the National Cancer Institute, and the Fred Hutchinson Cancer Research Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Also supported by the American Cancer Society Institutional Research Grant (to A.E.-J.).

Publisher Copyright:
© 2018 American Society for Blood and Marrow Transplantation

Keywords

  • Anxiety
  • Chronic graft-versus-host disease
  • Depression
  • Psychological distress
  • Transplant survivors

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