Quality of Life after High Dose Chemotherapy with Autologous Hematopoietic Progenitor Cell Support Long Term Follow-Up.

Background: High Dose Chemotherapy with Autologous Hematopoietic Progenitor Cell Support (HDC/AutHPCS) is a cancer treatment which provides potential for improved survival and risk for short and long term treatment side effects. Self report of QOL outcomes can guide risk assessment and system improvements to optimize care and rehabilitation.

Purpose: This study examined and compared over time, the quality of life outcomes for patients who have undergone this treatment.

Design: The Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT v.3) was the survey instrument used to measure QOL. Respondents were also asked to report their performance status based on the Eastern Co-operative Oncology Group (ECOG) and the New York Heart Association (NYHA) Performance status scales. Two open-ended questions were asked: what ”Good”, or “Bad” things occurred related to the treatment. Additional questions were asked about sleep problems that occurred after transplant, and whether a structured exercise program would have helped after discharge.

Method: A survey was mailed in November, 2005.

Sample: Patients (n=145) who had this treatment at our institution were contacted by mail. Diagnoses included acute myeloid leukemia, lymphoma, multiple myeloma, amyloid, breast cancer, and testicular cancer.

Data analysis: Scores for the FACT-BMT were analyzed using SPSS 14 (SPSS Inc., Chicago IL). Qualitative responses were analyzed using NVivo v.7 software.

Results: The return rate was 57% (n=81). The FACT-BMT Scores, subscales and total scores were comparable to other findings in similar studies and populations.

There were no statistically significant differences in scores from past studies with this population at this institution. Significant correlations were found between the scores of items in the FACT-BMT for which ≥ 25% of respondents reported low item ratings and the self rating ECOG and/or NYHA performance scales. Significant differences were also found when comparing the FACT-BMT Scores, subscales and total scores with demographic attributes such as, marital status, living situation, health insurance, employment status, and income. Twenty-five per cent (n=21) of respondents described new problems with sleep and 54% (n= 41) of respondents reported that a structured exercise program would have been beneficial for recovery. There were 21 respondents who participated in this survey (2006) and two prior surveys (1997 and 1999). Content and themes of their unsolicited and solicited written responses of their self reported lived experiences over time will be presented.

Conclusions: Overall, participants reported good quality of life. Based on demographics, there were subgroups identified potentially needing assessments and interventions focused on physical, social, emotional, and functional well being. This could be accomplished through a more focused pre-admission and follow-up needs assessment to identify patients who would potentially benefit from additional resources for psychosocial support, sleep and exercise/activity issues.