Quality of Life Scores Pre and Post Autologous Stem Cell Transplant for Patients with Lymphoid Malignancies

We performed prospective quality of life assessments on 304 patients with non-Hodgkin’s lymphoma (NHL), Hodgkin’s disease (HD), or Multiple Myeloma (MM), undergoing an autologous stem cell transplant (ASCT) from June 2003 through December 2007. Patients underwent QOL assessment one to two weeks prior to stem cell mobilization for ASCT, and 40–44 days (Day 42) post ASCT. We used the Functional Assessment of Cancer Therapy–Bone Marrow Transplant (FACT-BMT) assessment tool which includes five component scores: physical well being (PWB), social well being (SWB), emotional well being (EWB), functional well being (FWB), and additional concerns (AC). The total scores the sum of the score of the five components. We also administered a Profile of Mood State (POMS) scale which measures depression, vigor, anger, tension, confusion, and fatigue. Of 304 total patients, 65% had NHL, 21% MM, and 14% HD; median age was 53; 60% were male; 25% received prior radiation therapy; preparative regimens were busulfan based or melphalan; all patients received peripheral stem cells alone, median inpatient length of stay was 21 days. Using the FACT scale, there was a significant change from baseline data to day 42 scores. 218/304 patients completed baseline and Day 42 evaluations. Compared to baseline, patients had a significantly increased day 42 EWB score (p < 0.001), which occurred despite the fact that the functional well being scores decreased in a statistically significant fashion (p = 0.002). Using the POMS tool, statistically significant changes from baseline to day 42 were a reduction in depression (p < 0.001), a reduction in anger (p < 0.001), a reduction in tension (p < 0.001), and a reduction in confusion (p < 0.001), which occurred despite the fact that patients also had a reduction in vigor (p < 0.001). We conclude that using these two QOL tools despite a reduction in functional well being and vigor one month after ASCT, other parameters of coping, including emotional well being, depression, anger, and tension, improve as patients are recovering from the transplant experience. We hypothesize that this reflects resolution of pre transplant fears and anxiety. Whether these scores can be further improved with additional intervention requires further study.