Risk Factors for Depression and Fatigue Among Hematopoietic Cell Transplant (HCT) Recipients

Background: Previous research suggests that patients treated with HCT often experience elevated levels of depression and fatigue, but analyses to determine risk factors have typically lacked statistical power.  The goal of the current study was to examine sociodemographic and clinical risk factors for depression and fatigue in a large cohort of HCT survivors.

Methods:  Measures of depression (Patient Health Questionnaire – 8) and fatigue (Fatigue Symptom Inventory) were included in the annual survey of HCT recipients transplanted at Fred Hutchison Cancer Research Center.  The survey also included self-reported sociodemographic, health, and medication information. Patient clinical characteristics were obtained from the clinical database.  Analyses were conducted using continuous outcomes.

Results: The sample consisted of 1869 recipients (mean age 56, 53% male) with complete depression and fatigue data (response rate of 40.8%).  A total of 13% of participants reported moderate to severe depression; 42% reported moderate to severe fatigue.  Participants were a median of 8 years from transplant (range 0.5-40 years).  Depression was significantly associated with fatigue severity (r=.73, p<.0001) and fatigue disruptiveness (r=.80, p<.0001).  Univariate analyses indicated that female gender, younger age, chronic pain, second malignancy, allogeneic HCT, and receipt of peripheral blood stem cells (vs. bone marrow) were associated with greater depression, fatigue severity, and fatigue disruptiveness (p values < .05).  Among allogeneic recipients, self-reported current and past chronic graft-versus-host disease (GVHD) symptomatology were associated with increased depression, fatigue severity, and fatigue disruptiveness (p values < .05).  Extent of HLA match, myeloablative regimen, total body irradiation dose, and patient and donor cytomegalovirus status were not associated with depression or fatigue (p values > .05).  Multiple regression analyses using significant univariate predictors in the full sample indicated that female gender, younger age, chronic pain, and receipt of peripheral blood stem cells were independently associated with greater depression and fatigue (p values < .05).

Conclusions:  Data from the current study indicate that females, younger patients, those with chronic pain, and those who received peripheral blood stem cells are at higher risk for fatigue and depression. The relatively high rates of depression and fatigue in this group of survivors suggest a high symptom burden.  Better screening, referral, and interventions are needed. 

Funding:  NIH P01-CA018029