Stability and Priority of Symptoms and Symptom Clusters Among Allogeneic HSCT Patients Within a 5-Year Longitudinal Study

• Published in: Journal of pain and symptom management 2017-10, Vol.54 (4), p.493-500
• Main Authors: Esser, Peter, Kuba, Katharina, Scherwath, Angela, Johansen, Christoffer, Schwinn, Anke, Schirmer, Lena, Schulz-Kindermann, Frank, Kruse, Margitta, Koch, Uwe, Zander, Axel Rolf, Kröger, Nicolaus, Götze, Heide, Mehnert, Anja
• Format: Article
• Language: English
• Subjects: Anxiety; Appetite loss; Blood diseases; Cancer Survivors; chronic fatigue disorder; Disease Progression; Dyspnea; Factor analysis; Factor Analysis, Statistical; Fatigue; Fatigue - epidemiology; Fatigue - etiology; Fatigue - physiopathology; Female; Follow-Up Studies; Hematologic cancer; hematologic malignancy; hematopoietic stem cell transplantation; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; long-term survivor; Longitudinal Studies; Male; Medical research; Middle Aged; Multicenter studies; Nausea; Neoplasms - epidemiology; Neoplasms - physiopathology; Neoplasms - therapy; Quality of Life; Questionnaires; Severity; Stem cell transplantation; Stem cells; Surveys and Questionnaires; Symptom clusters; Symptom management; Transplantation, Homologous; Vomiting
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2017.07.012

Due to toxicity and invasiveness, allogeneic hematopoietic stem cell transplantation causes severe and longstanding symptom burden. Longitudinal studies on symptoms and symptom clusters (SC) would be helpful to optimize symptom control but are rare to date. The objective of this study was to investigate stability of symptoms, extract time stable SC, and determine their priority in symptom management. In this multicenter study, patients diagnosed with hematologic cancer were assessed before conditioning (T0) and three months (T1), one year (T2), and five years (T3) after transplantation. Symptoms were assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Symptoms were stable when rated as present at three consecutive time points. Applying factor analysis, stable SC were composed of symptoms loading on the same factor across all time points. Priority in symptom management was derived from a combination of severity and predictive power for quality of life (QoL). Two hundred thirty-nine patients participated at T0, 150 (63%) at T1, 102 (43%) at T2, and 45 (19%) at T3. We identified three stable SC, composed of rest-tired-weak-dyspnea-loss of appetite (exhausted), tense-worried-irritable-depressed (affective), and nausea-vomiting (gastrointestinal). Fatigue was most persistent and also most severe and predictive for QoL, both as symptom and in cluster (exhausted). Given its high stability, severity, and impact on QoL, fatigue should have priority in symptom management. The treatment of this symptom could be enhanced by also incorporating interventions addressing dyspnea and loss of appetite.