| Hematopoietic stem cell transplantation(HSCT)is the most effective treatment for hematologic malignancy.However,the strong immunosuppressive therapy before transplantation and the complications after transplantation may cause damage to the patients' physical function,and the heavy economic stress would inevitably affect the recovery after transplantation.With the prolongation of the disease-free survival time,people pay more and more attention to the quality of life(QOL),and not only to evaluate the curative effect of transplantation by survival rate after transplantation.Objective:The aim of this longitudinal study was to explore the changes of QOL during the 6 months period,and to identify associated factors of QOL among HSCT recipients.Methods:A total of 191 patients who underwent HSCT were selected by convenient in hematology department of the First Affiliated Hospital of Soochow University,and participants were recruited from July 2016 to April 2017.A series of measures were completed among 191 HSCT patients before transplantation and 1,3 and 6 months post-transplantation.The measures administered included the Functional Assessment of Cancer Therapy-Bone Marrow Transplant(FACT-BMT)questionnaire and the Perceived Social Support Scale(PSSS).We also evaluated HSCT patients' demographic characteristics and clinical disease information.Results:1.Patients' general information(1)Study enrollment and participation A total of 191 participants were enrolled in the study and each completed the questionnaires before transplantation.The number of participants at 1,3,and 6 months post-transplantation was 182(95.3%),162(84.8%),and 138(72.3%),and the effective rate of the questionnaires were 100%.The overall dropped out sample was 53,and the rate was 27.7%.(2)General data description for all patients Of the 191 patients,the mean age of participants was(33.90±12.01)years;117(61.3%)were male and 74(38.7%)were female;57(29.8%)were unmarried and 134(70.2%)were married;81(42.4%)were rural residences and 110(57.6%)were nonrural residences;58(30.4%)with junior high school and below education,53(27.7%)with high school education,and 80(41.9%)with diploma and above education;45(23.5%)with less than 2000 yuan/month household income,75(39.3%)with 2001~4000 yuan/month household income,and 71(37.2%)with more than 4001yuan/month household income;100(52.4%)with the major caregivers of lovers,81(42.4%)with the major caregives of parents and 10(5.2%)with the major caregivers of others;119(62.3%)were diagnosed with acute leukemia and 72(37.7%)were diagnosed with nonacute leukemia;177(92.7%)received allogeneic transplantation and 14(7.3%)received allogeneic transplantation;163(85.3%)prepared with bucy and 28(14.7%)prepared with nonbucy;the HLA compatibility of 67(35.1%)were fully compatible,and 124(64.9%)were not identical;156(81.7%)platelet has been rebuilt and 35(18.3%)without reconstruction when discharging;123(64.9%)occurred transplant-related complications and 68(35.1%)without transplant-related complications.(3)General information comparison of the missing sample with the rest of sample We compared the general information of the missing sample(n = 53)and the rest of the samples(n = 138),which came from patients who completed all the measurements at the 4 time points and found that there was no statistical difference in characteristics between the 2 groups.Therefore the missing values were ignored in our data analysis.(4)The incidence of transplant-related complications During the study period,101(73.2%)patients in 138 patients had occurred transplant-related complications.There were 91 complications occurred from pre-transplantation to 1 month after transplantation,55 complications occurred from 1 month to 3 months after transplantation,and 10 complications occurred from 3 months to 6 months after transplantation.2.Socail support in patients with HSCT The social support level of 138 patients before transplantation was(67.05±12.00),which belonged to the high support level.Friend support scores slightly lower than the family support dimension and other support dimension scores.3.QOL in patients with HSCT(1)The total score of FACT-BMT at different time points The scores were(110.31±14.99),(105.07±18.85),(106.71±18.34)and(108.16±18.34),respectively,before transplantation,and at 1 month,3 months and 6 months after transplantation.It was lowest at 1 month after transplantation,and a statistically significant increase was found at 6 months after transplantation(P<0.05),but was still lower than before transplantation level.(2)The passing rate of FACT-BMT at different time points The passing rate of FACT-BMT score among 138 patients was between 79.0%~92.8% at different time points.(3)Comparison of similar studies abroad The results of this study were similar to those of Sirilla'.Before transplantation and at 1 month after transplantation,the results of this study were higher than those of Sirilla'(110.3 vs 103.7,105.1 vs 97.2),and the results were almost close at 3 months after transplantation(106.7 vs 105.0),the results of this study were slightly lower than that of Sirilla'(108.2 vs 110.2)at 6 months after transplantation.(4)Changes of QOL's dimensions The score of physical well-being(PWB)was the lowest at 1 month after transplantation,and was significantly improved at 3 months after transplantation(P<0.05);The score of social/family well-being(SWB)decreased gradually with time going on(P<0.001);and emotional well-being(EWB)showed a trend of continuous increase with time going on(P<0.05);Functional well-being(FWB)were the lowest at 1 month after transplantation,and were significantly improved at 6 months after transplantation(P<0.05);The score of bone marrow transplantation specific concerns(BMTS)was the lowest at 1 month after transplantation,however,there was no statistically significant improvement at 6 months after transplantation(P>0.05).(5)Comparison between different dimensions at the same time point During the study period,we found that patients' FWB was most severely damaged.4.Factors associated with QOL of HSCT recipients(1)GEE showed that factors affecting the QOL of HSCT patients including social support(?=9.103,P=0.001),transplant-related complications(?=-8.008,P<0.001),residence(?=6.137,P=0.006),and household income(?=0.6.403,P=0.008).(2)Analysis of population characteristics(1)Social support Compared with patients with high support level,the QOL of patients with intermediate support level was lower during the peri-transplant period(P<0.05),and the QOL decreased rapidly after transplantation,and the difference of QOL was maximal between the two groups at 1 months after transplantation(P<0.05).(2)Transplant-related complications Compared with patients with no transplant-related complications,the QOL in patients with complications was lower at 1,3 and 6 months after transplantation(P<0.05),and the QOL decreased significantly after transplantation,reached the lowest at 1 months after transplantation(P<0.05),and the recovery was extremely slow at 3 and 6 months after transplantation.The difference between the two groups in QOL was maximal at 6 months after transplantation(P<0.05).(3)Residence Compared with those who lived in non-rural areas,the QOL of rural patients during peri-transplant period is lower(P<0.05),the QOL decreased rapidly after transplantation and reduced to a minimum at 1 month after transplantation(P<0.05),while the recovery was slow after transplantation.The difference between the two groups in QOL was maximized at 6 months after transplantation(P< 0.05).(4)Household income Compared with patients with 4001 yuan/month and above,the QOL of patients with 2000 yuan/month and below were lower at 1,3 and 6 months after transplantation(P<0.05),and their QOL decreased faster after transplantation,the lowest at 3 months after transplantation(P<0.05),and there was no significant improvement at 6 months after transplantation.Conclusion:1.The QOL in HSCT patients decreased during the peri-transplant period,and it changed at different time points of transplantation.The QOL was the worst at 1 month after transplantation and significantly improved at 6 months after transplantation.Therefore,clinical medical staff should attach great importance to the QOL of HSCT patients in the early stage of transplantation,and try to take targeted intervention measures at the first time.2.The QOL of HSCT patients during peri-transplantation period was influenced by social support,transplant-related complications,residence,and household income.And we should take measures from multiple aspects to improve the QOL of patients,providing rehabilitation guidance for patients after transplantation to help them return to normal life. |
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