Factors associated with adherence to preventive care practices among hematopoietic cell transplantation survivors.
Khera N, Chow EJ, Leisenring WM, Syrjala KL, Baker KS, Flowers MED, Martin PJ, Lee SJ. Biol Blood Marrow Transplant 2011; 17: 995-1003.
After transplants, people are at higher risk of many medical conditions, so physicians recommend many healthy habits to try to prevent new diseases and screening tests to detect problems early. Since many people do not follow their physician’s recommendations, researchers conducted a survey to determine the percentage of people who were following the guidelines and to understand barriers. Between July 2008 and July 2009, 1549 previous patients from the Fred Hutchinson Cancer Research Center who were transplanted between 1972-2008 responded to the survey. Only 75% of people had recommended medical screening tests even though 98% of the people had medical insurance. People who did not have the recommended screening tests and healthy habits had concerns about medical costs, had their transplant a long time ago, or were not aware of the recommended tests. People who had chronic graft-versus-host disease were more likely to follow screening recommendations. Results of this study suggest that although most people are getting the recommended screening tests after transplantation, about a quarter of screening and preventive guidelines are not being followed, adversely affecting the health of survivors. Better patient and doctor education and lower costs may help improve screening rates.
Influence of conventional cardiovascular risk factors and lifestyle characteristics on cardiovascular disease after hematopoietic cell transplantation.
Chow EJ, Baker KS, Lee SJ, Flowers ME, Cushing-Haugen KL, Inamoto Y, Khera N, Leisenring WM, Syrjala KL, Martin PJ. J Clin Oncol 2014; 32: 191-198.
A healthy lifestyle can reduce the risk of heart problems, but there is little information about whether a person’s lifestyle after transplant matters. This study tried to determine whether people recovering from hematopoietic cell transplantation (HCT) could reduce their risk of heart disease by practicing healthy habits. Researchers compared 2362 survey responses between July 2010 and February 2012 from people who underwent transplantation at the Fred Hutchinson Cancer Research Center. The study then compared responses to the results of the National Health and Nutrition Examination Survey. Analyses indicated that people who did not eat a lot of fruits and vegetables had a higher risk of diabetes and those with low physical activity had higher risks of high blood pressure and diabetes. Overall, the study concluded that living a healthy lifestyle can reduce the risk of severe complications after transplant. Results of this study mean that it is very important that transplant survivors try to live a healthy lifestyle after a transplant to lower their risk of heart disease.
Late cardiovascular complications after hematopoietic cell transplantation.
Chow EJ, Wong K, Lee SJ, Cushing-Haugen KL, Flowers ME, Friedman DL, Leisenring WM, Martin PJ, Mueller BA, Baker KS. Biol Blood Marrow Transplant 2014; 20: 794-800
After a transplant, some people develop heart disease. This study asked whether certain health factors from before, during, and after the transplant are associated with higher risks of heart disease. By analyzing the medical records of 1379 Washington Residents who received blood, bone marrow or cord blood transplantation at the Fred Hutchinson Cancer Research Center between 1985-2005, researchers concluded that people who smoked or had diabetes before transplantation had a higher risk of heart disease. Additionally, people who had preexisting, newly developed, or persistent cardiovascular problems had a greater risk of developing another heart problem. This study is important because transplant survivors who already have risk factors for heart disease are at an even higher risk after transplant.
Resilience, health, and quality of life among long-term survivors of hematopoietic cell transplant.
Rosenberg AR, Syrjala KL, Martin PJ, Flowers ME, Carpenter P, Salit RB, Baker KS, Lee SJ; Cancer 2015; 121: 4250-4257.
Being physically and psychologically healthy (resilient) can reduce the strain of health problems in daily life. This study explored how patient-reported resilience correlated with stress and quality of life for people who received their transplant at Fred Hutchinson Cancer Research Center. Researchers assessed 1823 responses between July 2013 and June 2014 from past transplant patients and determined that people with low resilience had higher severity of chronic graft-versus-host disease and stress and missed more work days. This study suggests that resilience is challenged by health issues and efforts to increase resilience in transplant survivors may be helpful.
Risk factors for depression and fatigue among survivors of hematopoietic cell transplantation.
Jim HS, Sutton SK, Jacobsen PB, Martin PJ, Flowers ME, Lee SJ. Cancer 2016; 122: 1290-1297.
After transplant, two of the most common and serious symptoms people experience are depression and fatigue. Between July 2012 and June 2013, researchers surveyed 1869 people who underwent transplantation at the Fred Hutchinson Cancer Research Center/ Seattle Cancer Care Alliance. Results indicated that people who were younger, had chronic pain, or had severe chronic graft-versus-host disease tended to display greater signs of fatigue or depression suggesting that better control of pain and chronic graft-versus-host disease might decrease depression and fatigue.
Morbidity and mortality differences between hematopoietic cell transplantation survivors and other cancer survivors.
Chow EJ, Cushing-Haugen KL, Cheng GS, Boeckh M, Khera N, Lee SJ, Leisenring WM, Martin PJ, Mueller BA, Schwartz SM, Baker KS. J Clin Oncol 2016; 35: 306-313.
After recovering from a bone marrow or blood stem cell transplant, people are more likely to develop second illnesses. This study determined whether people recovering from hematopoietic cell transplantation (HCT) have the same risk of developing a second illness as other cancer survivors. Researchers compared the health of three groups of people: those who received HCT at least two years earlier, 2-year cancer survivors records from the Washington State Cancer Registry, and the general population. The researchers determined that people who had HCT were more likely to be hospitalized and be diagnosed with a second cancer than the other two groups of people.
PROMIS measures can be used to assess symptoms and function in long-term hematopoietic cell transplantation survivors.
Shaw BE, Syrjala KL, Onstad L, Chow EJ, Flowers ME, Jim H, Baker KS, Buckley S, Fairclough D, Jensen RE, Horowitz MM, Lee SJ. Cancer 2018; 124: 841-849.
PROMIS is a new type of survey developed by the National Institutes of Health to measure the quality of life and symptoms of people with different diseases. Because the survey is new, researchers tested whether PROMIS worked as well as the standard annual survey. 1634 people who received their transplants at the Fred Hutchinson Cancer Research Center filled out both surveys between July 2015 and June 2016. The results indicate that all the components of the PROMIS survey (the physical, mental, vitality and pain) produced similar results to the old survey. Therefore, the researchers concluded that PROMIS is just as good and offers some advantages compared to the survey questions we currently use. We will start using the PROMIS measures in 2020.
Lifestyle factors and subsequent ischemic heart disease risk after hematopoietic cell transplantation.
Leger KJ, Baker KS, Cushing-Haugen KL, Flowers MED, Leisenring WM, Martin PJ, Mendoza JA, Reding K, Syrjala KL, Lee SJ, Chow EJ. Cancer 2018; 124: 1507-1515.
A growing number of people undergo hematopoietic cell transplantation (HCT) but we know that people who are transplanted have a higher risk of heart disease. The objective of this study was to test whether healthy lifestyle factors could affect the risk of heart disease in HCT recipients. Thanks to the responses of 2360 former Fred Hutchinson Cancer Research Center patients, researchers could assess whether obesity, diabetes, low physical activity, and low fruit/vegetable intake were associated with heart disease. They concluded that each of the lifestyle and cardiovascular risk factors were associated with cardiovascular disease, suggesting that living a healthy lifestyle after transplant is important to lower your risk of heart disease.
Patient-reported outcomes and health status associated with chronic GVHD.
Lee SJ, Onstad L, Chow EJ, Shaw BE, Jim HSL, Syrjala KL, Baker KS, Buckley S, Flowers ME. Haematologica 2018, 103: 1535-1541.
The PROMIS system is a new survey to measure the quality of life and symptoms of people with medical conditions. However, there has been little study on whether the PROMIS survey can accurately analyze the health of people with chronic graft-versus-host disease (GVHD). Researchers gathered the responses of 1377 previous transplanted patients to both the PROMIS and standard annual survey. Since both systems had similar results when measuring the health of people with chronic GVHD, the PROMIS measure can replace the standard annual survey when assessing how chronic GVHD affects quality of life.
Quality of life of caregivers of hematopoietic cell transplant recipients.
Jamani K, Onstad LE, Bar M, Carpenter PA, Krakow EF, Salit RB, Flowers ME, Lee SJ. Biol Blood Marrow Transplant 2018; 24: 2271-2276.
Caregivers provide very important support to the recipient before, during, and after the transplant. Therefore, it is crucial to understand both the physical and mental health of caregivers. After an overall average of six years after transplant, 68% of 849 caregivers still provided care for their care recipient. Additionally, approximately 20% of caregivers reported a low health and happiness because of depression and sleep disorders. Researchers determined that there were both caregiver and recipient factors that affected the caregiver’s health. These consisted of the caregiver’s age, gender, education and the recipient's health, previous illness, and medication regimen.
Impact of psychological distress on quality of life, functional status, and survival in patients with chronic graft-versus-host disease.
El-Jawahri A, Pidala J, Khera N, Wood WA, Cutler C, Arora M, Carpenter PA, Palmer J, Flowers M, Weisdorf D, Jagasia M, Chen YB, Lee SJ. Biol Blood Marrow Transplant 2018: 2285-2292.
Little is known about the mental stress people with chronic graft-versus-host disease (GVHD) experience. This information is crucial since mental health can affect a person’s quality of life. Therefore, this study examined people’s self-reported depression and anxiety and compared it to their physical health. From a group of 482 past patients from the Chronic GVHD Consortium (a multi-center GVHD study), researchers found that those who reported depression or anxiety have lower quality of life and physical functioning.
Rates and risk factors for post-traumatic stress disorder among adult hematopoietic cell transplant recipients and their informal caregivers.
Liang J, Lee SJ, Storer BE, Shaw BE, Chow EC, Flowers ME, Krakow E, Bar M, Syrjala K, Salit RB, Kurukulasuriya C, Jim H. Biol Blood Marrow Transplant 2019, 25: 145-150.
Hematopoietic cell transplantation (HCT) can cause a lot of stress for both patients and their caregivers. Few studies have evaluated whether patients and their caregivers develop Post-Traumatic Stress Disorder (PTSD) after HCT. From 2157 HCT recipients and their caregivers, researchers calculated that 6.6% of caregivers reported PTSD and 3.3% of patients. These rates of PTSD were lower than predicted. Nevertheless, the results are consistent with other studies of cancer caregiving and suggests that caregivers often experience greater distress than patients.