A Single Center Survey of Distress Amongst Bone Marrow Transplant Recipients

Introduction: Patients diagnosed with cancer may experience psychological issues that can interfere with treatment plans and adversely affect outcomes. Patients should be screened for distress during pivotal medical visits. The St. Louis University Blood and Marrow Transplant Program (SLUBMT) began implementing the State Trait Anxiety Inventory (STAI) with patients during medical visits to evaluate feelings of anxiety. Under normal conditions, average STAI scores are: 35.72 (state)/34.89 (trait) for working, male adults and 35.20 (state)/34.79 (trait) for working, female adults.  After implementing the STAI, it was realized that these screenings could be analyzed in groups to determine if patterns emerged regarding patients' anxiety throughout the bone marrow transplantation (BMT) process. The STAI has been utilized in studies to determine the effectiveness of interventions to decrease anxiety; however the study team is unable to find longitudinal studies which examine how STAI scores are naturally affected over the course of the BMT process.

Method: Institutional Review Board approval was received to perform a retrospective examination of STAIs completed by patients throughout the BMT process at the SLUBMT from 03/11/14 through 06/24/14. 30 inventories were collected, de-identified, and categorized by the following medical visits: arrival visit (first visit to the clinic), data review visit (visit to review transplant related testing and sign consents), start of preparative regimen visit, day 0 visit, day +30 bone marrow biopsy visit for allogenic transplantation, day +30 bone marrow biopsy result visit for allogenic transplantation, and day +100 visit for auto transplantation. Averages for each category were determined by finding the mean score. Scores were then compared to determine which medical visit(s) caused patients to experience an increase in anxiety.

Results: Average scores were 46 (state)/38 (trait) during the arrival visits, 41 (state)/45 (trait) during the data review visits, and 44 (state)/39 (trait) during the start of preparative regimen visits. During day 0 visits, patients' scores decreased to an average of 36 (state)/35 (trait). Day +30 and day +100 visits demonstrated even further decreases in anxiety scores.

Conclusion: Patients experience the highest levels of anxiety during early medical visits of the BMT process. The sample size was small and could possibly skew results. However, this study does provide a starting basis for future study in BMT recipient distress, and multi-site studies are being planned to ensure the accuracy of the patterns, which emerged from this study. If patterns could be accurately predicted, the study team may also be able to develop future studies to preemptively lower patients' anxiety levels early in the BMT process and thus improve outcomes.