219 Prognostic Understanding, Quality of Life, and Mood in Patients Undergoing Hematopoietic Stem Cell Transplantation

Track: Poster Abstracts
Wednesday, February 11, 2015, 6:45 PM-7:45 PM
Grand Hall CD (Manchester Grand Hyatt)
Areej El-Jawahri, MD , Hematology-Oncology, Massachusetts General Hospital, Boston, MA
Lara Traeger, PhD , Psychology, Massachusetts General Hospital, Boston, MA
Kailyn Kuzmuk , Massachusetts General Hospital, Boston, MA
Justin Eusebio , Massachusetts General Hospital, Boston, MA
Harry Vandusen , Massachusetts General Hospital, Boston, MA
Tanya Keenan, MD , Massachusetts General Hospital, Boston, MA
Jennifer Shin , Massachusetts General Hospital, Boston, MA
Emily Gallagher , Massachusetts General Hospital, Boston, MA
Joseph Greer, PhD , Psychology, Massachusetts General Hospital, Boston, MA
William Pirl, MD , Psychiatry, Massachusetts General Hospital, Boston, MA
Vicki Jackson, MD , Palliative Care, Massachusetts General Hospital, Boston, MA
Karen K. Ballen, MD , Massachusetts General Hospital, Boston, MA
Thomas R. Spitzer, MD , Bone Marrow Transplantation Unit, Massachusetts General Hospital, Boston, MA
Timothy Graubert, MD , Hematology-Oncology, Massachusetts General Hospital, Boston, MA
Steven L. McAfee, MD , BMT Program, Dept of Medicine, Massachusetts General Hospital, Boston, MA
Bimalangshu R Dey, MD, PhD , Bone Marrow Transplant Unit, Massachusetts General Hospital, Boston, MA
Yi-Bin Chen, MD , Massachusetts General Hospital, Boston, MA
Jennifer Temel, MD , Oncology, Massachusetts General Hospital, Boston, MA
Presentation recording not available for download or distribution as requested by the presenting author.

Background: In advanced cancers, patients' prognostic perceptions influence their medical decisions. However, little is known about how patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HCT) and their family caregivers (FC) understand their prognosis. We examined prognostic perception in these patients during hospitalization for HCT and its relationship with QOL and mood.

Methods: We conducted a longitudinal study of patients (and FC) hospitalized for HCT.  At baseline (6 days pre-HCT), we used a 10-item questionnaire to measure patients' and FC information preferences, and perception of prognosis. Using 2-items, we also asked the treating oncologists regarding the patients' prognosis.  At day-6, day+1, day+8 of HCT, we assessed QOL (Functional Assessment of Cancer Therapy-Bone Marrow Transplantation FACT-BMT), and mood (Hospital Anxiety and Depression Scale). We examined the relationship between patients' prognostic perception and their QOL and mood during hospitalization for HCT using multivariable linear mixed models.

Results:  We enrolled 97% of consecutively eligible patients undergoing autologous (n=30), myeloablative (n=30) or reduced intensity (n=30) allogeneic HCT. Most patients (80/90, 88.9%) and FC (41/47, 87.1%) believed that it is ‘extremely' or ‘very' important to know about prognosis [Figure 1A]. However, the majority of patients (66/85, 77.6%) and FC (33/46, 71.7%) reported an inaccurate and more optimistic perception of the patients' prognosis compared to the oncologist (P's < 0.0001) [Figure 1B]. Patients with accurate prognostic understanding reported lower QOL (P = 0.03) and worse depressive symptoms (P = 0.04) with a steeper increase in depression (P = 0.006) over time compared to patients with an inaccurate optimistic prognostic perception. 

Conclusions: The majority of patients and FC reported inaccurate and more optimistic perception of prognosis compared with the oncologist. Patients with an accurate perception of their prognosis had lower QOL, higher depression, and a steeper increase in depression during hospitalization for HCT. Interventions are needed to improve prognostic understanding while providing adequate psychosocial support during HCT.

Figure 1A

 

Figure 1B:

 

 

Disclosures:
Nothing To Disclose
See more of: Poster Session 1: Late Effects/Quality of Life/Psychosocial Issues
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