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Supportive Care in Cancer

, Volume 27, Issue 2, pp 591–600 | Cite as

Correlates of anxiety and depression symptoms among patients and their family caregivers prior to allogeneic hematopoietic cell transplant for hematological malignancies

  • Donna M. PoslusznyEmail author
  • Dana H. Bovbjerg
  • Karen L. Syrjala
  • Mounzer Agha
  • Mary Amanda Dew
Original Article
  • 85 Downloads

Abstract

Purpose

Given the complexities and risks of allogeneic HCT, patients and their family caregivers may experience elevated psychological distress, including symptoms of anxiety and depression, in anticipation of the procedure. Patients and caregivers also bring with them their pre-HCT experiences of diagnosis, prior treatment, and associated burdens, thus potentially compounding their acute distress. Identification of clinical, psychosocial, and sociodemographic factors related to pre-HCT distress would allow targeting of patients and caregivers who may require assistance during the HCT process.

Methods

Consecutive patients (n = 111) and their caregivers (n = 110) completed measures of anxiety, depression, cancer distress, perceived threat, perceived control, self-efficacy, relationship quality, and physical quality of life in the week before HCT. Multivariate linear regression analysis was used to identify factors associated with patient and caregiver anxiety or depression, including disease type, donor type, and patient and caregiver sociodemographic, health-related, and psychosocial factors.

Results

Family caregivers had higher levels of anxiety and depression symptoms than patients. Thirty percent of caregivers vs. 17% of patients met criteria for clinically significant anxiety and a lesser amount (5% for both) met criteria for clinically significant depression. Patient anxiety was related to younger age (b = − 0.22, p = 0.005) and greater cancer-related distress (b = 0.59, p < 0.001), while caregiver anxiety was related to lower self-efficacy (b = − 0.19, p = 0.011) and greater cancer-related distress (b = 0.58, p < 0.001). Similarly, patient depression was related to lower perceived control (b = − 0.17, p = 0.050), greater cancer-related distress (b = 0.34, p = 0.005), and lower physical functioning (b = − 0.26, p = 0.008), while caregiver depression was related to greater cancer-related distress (b = 0.46, p < 0.001).

Conclusions

Family caregivers may be more emotionally vulnerable than patients before HCT and in need of additional assistance. Cancer-related distress was the strongest correlate of anxiety and depression in both patients and caregivers, suggesting that distress related to their cancer experience and its consequences plays a major role in their emotional functioning prior to HCT.

Keywords

Anxiety Depression Family caregiver Hematological malignancies Transplantation 

Notes

Funding information

This study was supported by grants K23CA149082 and P30CA047904 from the National Cancer Institute.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This research was conducted in compliance with ethical standards.

Supplementary material

520_2018_4346_MOESM1_ESM.docx (56 kb)
ESM 1 (DOCX 56 kb)

References

  1. 1.
    Majhail NS, Farnia SH, Carpenter PA, Champlin RE, Crawford S, Marks DI, Omel JL, Orchard PJ, Palmer J, Saber W, Savani BN, Veys PA, Bredeson CN, Giralt SA, LeMaistre CF (2015) Indications for autologous and allogeneic hematopoietic cell transplantation: guidelines from the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 21(11):1863–1869CrossRefGoogle Scholar
  2. 2.
    National Marrow Donor Program (NMDP) (2015) Patient Care Guidelines: Allogeneic transplant: How to plan and what to expect. http://www.marrow.org
  3. 3.
    El-Jawahri A et al (2017) Impact of pre-transplant depression on outcomes of allogeneic and autologous hematopoietic stem cell transplantation. Cancer 123(10):1828–1838CrossRefGoogle Scholar
  4. 4.
    Pillay B, Lee SJ, Katona L, Burney S, Avery S (2014) Psychosocial factors associated with quality of life in allogeneic stem cell transplant patients prior to transplant. Psychooncology 23(6):642–649CrossRefGoogle Scholar
  5. 5.
    Syrjala KL, Langer S, Abrams J, Storer B, Martin P (2004) Physical and mental recovery after hematopoietic stem cell transplantation. Discov Med 4(23):263–269PubMedGoogle Scholar
  6. 6.
    Prieto JM, Atala J, Blanch J, Carreras E, Rovira M, Cirera E, Gastó C (2005) Patient-rated emotional and physical functioning among hematologic cancer patients during hospitalization for stem-cell transplantation. Bone Marrow Transplant 35(3):307–314CrossRefGoogle Scholar
  7. 7.
    Simoneau TL, Mikulich-Gilbertson SK, Natvig C, Kilbourn K, Spradley J, Grzywa-Cobb R, Philips S, McSweeney P, Laudenslager ML (2013) Elevated peri-transplant distress in caregivers of allogeneic blood or marrow transplant patients. Psychooncology 22(9):2064–2070CrossRefGoogle Scholar
  8. 8.
    Beattie S, Lebel S (2011) The experience of caregivers of hematological cancer patients undergoing a hematopoietic stem cell transplant: a comprehensive literature review. Psychooncology 20(11):1137–1150CrossRefGoogle Scholar
  9. 9.
    Bevans M, Wehrlen L, Prachenko O, Soeken K, Zabora J, Wallen GR (2011) Distress screening in allogeneic hematopoietic stem cell (HSCT) caregivers and patients. Psychooncology 20(6):615–622CrossRefGoogle Scholar
  10. 10.
    El-Jawahri AR et al (2015) Quality of life and mood of patients and family caregivers during hospitalization for hematopoietic stem cell transplantation. Cancer 121(6):951–959CrossRefGoogle Scholar
  11. 11.
    Syrjala KL, Yi JC, Langer SL (2016) Psychometric properties of the Cancer and Treatment Distress (CTXD) measure in hematopoietic cell transplantation patients. Psychooncology 25(5):529–535CrossRefGoogle Scholar
  12. 12.
    Baliousis M, Rennoldson M, Dawson D, Mills J, das Nair R (2017) Perceptions of hematopoietic stem cell transplantation and coping predict emotional distress during the acute phase after transplantation. Oncol Nurs Forum 44(1):96–107CrossRefGoogle Scholar
  13. 13.
    Fife BL, Monahan PO, Abonour R, Wood LL, Stump TE (2009) Adaptation of family caregivers during the acute phase of adult BMT. Bone Marrow Transplant 43(12):959–966CrossRefGoogle Scholar
  14. 14.
    Sarkar S, Scherwath A, Schirmer L, Schulz-Kindermann F, Neumann K, Kruse M, Dinkel A, Kunze S, Balck F, Kröger N, Koch U, Mehnert A (2014) Fear of recurrence and its impact on quality of life in patients with hematological cancers in the course of allogeneic hematopoietic SCT. Bone Marrow Transplant 49(9):1217–1222CrossRefGoogle Scholar
  15. 15.
    Wells KJ, Booth-Jones M, Jacobsen PB (2009) Do coping and social support predict depression and anxiety in patients undergoing hematopoietic stem cell transplantation? J Psychosoc Oncol 27(3):297–315CrossRefGoogle Scholar
  16. 16.
    Langer SL, Yi JC, Storer BE, Syrjala KL (2010) Marital adjustment, satisfaction and dissolution among hematopoietic stem cell transplant patients and spouses: a prospective, five-year longitudinal investigation. Psychooncology 19(2):190–200CrossRefGoogle Scholar
  17. 17.
    Ferraro KF, Su Y (1999) Financial strain, social relations, and psychological distress among older people: a cross-cultural analysis. J Gerontol B Psychol Sci Soc Sci 54((1):S3–S15Google Scholar
  18. 18.
    Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483CrossRefGoogle Scholar
  19. 19.
    Katz JN et al (1996) Can comorbidity be measured by questionnaire rather than medical record review? Med Care 34(1):73–84CrossRefGoogle Scholar
  20. 20.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370CrossRefGoogle Scholar
  21. 21.
    Syrjala K (2005) The Cancer and Treatment Distress Scale (CTXD). Scoring manual obtained from the authorGoogle Scholar
  22. 22.
    Witte K et al (1996) Predicting risk behaviors: development and validation of a diagnostic scale. J Health Commun 1(4):317–341CrossRefGoogle Scholar
  23. 23.
    Christensen AJ, Moran PJ, Ehlers SL, Raichle K, Karnell L, Funk G (1999) Smoking and drinking behavior in patients with head and neck cancer: effects of behavioral self-blame and perceived control. J Behav Med 22(5):407–418CrossRefGoogle Scholar
  24. 24.
    Dew MA, Bromet EJ (1991) Effects of depression on social support in a community sample of women. In: Exner JE (ed) The social context of coping. Plenum, New York, pp 189–208CrossRefGoogle Scholar
  25. 25.
    Spanier GB (1978) Measuring dyadic adjustment: new scales for asessing the quality of marriage and similar dyads. J Marriage Fam 38(1):15–28Google Scholar
  26. 26.
    Pearlin LI, Schooler C (1978) The structure of coping. J Health Soc Behav 19(1):2–21CrossRefGoogle Scholar
  27. 27.
    Dew MA, DiMartini AF, DeVito Dabbs AJ, Fox KR, Myaskovsky L, Posluszny DM, Switzer GE, Zomak RA, Kormos RL, Toyoda Y (2012) Onset and risk factors for anxiety and depression during the first 2 years after lung transplantation. Gen Hosp Psychiatry 34(2):127–138CrossRefGoogle Scholar
  28. 28.
    Myaskovsky L, Posluszny DM, Schulz R, DiMartini AF, Switzer GE, Dabbs ADV, McNulty ML, Kormos RL, Toyoda Y, Dew MA (2012) Predictors and outcomes of health-related quality of life in caregivers of cardiothoracic transplant recipients. Am J Transplant 12(12):3387–3397CrossRefGoogle Scholar
  29. 29.
    Myaskovsky L, Dew MA, Switzer GE, Kormos RL, Hall M, Goycoolea JM, DiMartini AF, Manzetti JD, KR MC (2003) Avoidant coping is related to poorer quality of life among lung transplant candidates. Prog Transplant 13(3):183–192CrossRefGoogle Scholar
  30. 30.
    Dew MA et al (2004) Onset, timing and risk for depression and anxiety in family caregivers to heart transplant recipients. Psychol Med 34(6):1065–1082CrossRefGoogle Scholar
  31. 31.
    Dew MA, Kormos RL, DiMartini A, Switzer GE, Schulberg HC, Roth LH, Griffith BP (2001) Prevalence and risk of depression and anxiety-related disorders during the first three years after heart transplantation. Psychosomatics 42(4):300–313CrossRefGoogle Scholar
  32. 32.
    Jerusalem RSM (1995) Generalized self-efficacy scale. In: Weinman SWJ, Johnston M (eds) Measures in health psychology: a user's portfolio. Causal and control beliefs. NFER-NELSON, Windsor, pp 35–37Google Scholar
  33. 33.
    Puhan MA, Frey M, Büchi S, Schünemann HJ (2008) The minimal important difference of the hospital anxiety and depression scale in patients with chronic obstructive pulmonary disease. Health Qual Life Outcomes 6:46CrossRefGoogle Scholar
  34. 34.
    Chan KS, Aronson Friedman L, Bienvenu OJ, Dinglas VD, Cuthbertson BH, Porter R, Jones C, Hopkins RO, Needham DM (2016) Distribution-based estimates of minimal important difference for hospital anxiety and depression scale and impact of event scale-revised in survivors of acute respiratory failure. Gen Hosp Psychiatry 42:32–35CrossRefGoogle Scholar
  35. 35.
    Lang MJ, David V, Giese-Davis J (2015) The age conundrum: a scoping review of younger age or adolescent and young adult as a risk factor for clinical distress, depression, or anxiety in cancer. J Adolesc Young Adult Oncol 4(4):157–173CrossRefGoogle Scholar
  36. 36.
    Taylor SE, Helgeson VS, Reed GM, Skokan LA (1991) Self-generated feelings of control and adjustment to physical illness. J Soc Issues 47(4):91–109CrossRefGoogle Scholar
  37. 37.
    Wood WA, le-Rademacher J, Syrjala KL, Jim H, Jacobsen PB, Knight JM, Abidi MH, Wingard JR, Majhail NS, Geller NL, Rizzo JD, Fei M, Wu J, Horowitz MM, Lee SJ (2016) Patient-reported physical functioning predicts the success of hematopoietic cell transplantation (BMT CTN 0902). Cancer 122(1):91–98CrossRefGoogle Scholar
  38. 38.
    Ehrlich KB, Miller GE, Scheide T, Baveja S, Weiland R, Galvin J, Mehta J, Penedo FJ (2016) Pre-transplant emotional support is associated with longer survival after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 51(12):1594–1598CrossRefGoogle Scholar
  39. 39.
    Ugalde A, Krishnasamy M, Schofield P (2014) The relationship between self-efficacy and anxiety and general distress in caregivers of people with advanced cancer. J Palliat Med 17(8):939–941CrossRefGoogle Scholar
  40. 40.
    Mystakidou K, Tsilika E, Parpa E, Gogou P, Panagiotou I, Vassiliou I, Gouliamos A (2013) Relationship of general self-efficacy with anxiety, symptom severity and quality of life in cancer patients before and after radiotherapy treatment. Psychooncology 22(5):1089–1095CrossRefGoogle Scholar
  41. 41.
    Curtis R, Groarke A, Sullivan F (2014) Stress and self-efficacy predict psychological adjustment at diagnosis of prostate cancer. Sci Rep 4:5569CrossRefGoogle Scholar
  42. 42.
    Syrjala KL, Sutton SK, Jim HSL, Knight JM, Wood WA, Lee SJ, Jacobsen PB, Abidi MH, Yi JC (2017) Cancer and treatment distress psychometric evaluation over time: a BMT CTN 0902 secondary analysis. Cancer 123(8):1416–1423CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of PittsburghPittsburghUSA
  2. 2.UPMC Hillman Cancer CenterPittsburghUSA
  3. 3.Fred Hutchinson Cancer Research CenterSeattleUSA
  4. 4.University of WashingtonSeattleUSA

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