Study objective: To evaluate the influence of distress on overall survival of patients with hematologic malignancies who underwent allogeneic stem cell transplantation (allo-SCT) and to analyze the possible risk factors for death.
Design: Retrospective cohort study.
Setting: Large tertiary care teaching hospital.
Patients: Seventy-seven patients (aged ≥ 15 yrs) with hematologic malignancies who underwent allo-SCT between January 2000 and August 2007; 20 patients with distress history were matched in a 1:3 ratio with 57 patients without distress history.
Measurements and main results: The primary outcome was overall survival, defined as the time from allo-SCT to disease-related death or last date of follow-up. Secondary outcomes were time to hematologic recovery (absolute neutrophil count ≥ 500 cells/mm³) from day of allo-SCT, length of hospital stay, and opioid usage. Sociodemographic information and clinical characteristics were analyzed for possible risk factors. Patient history of psychological distress resulted in a significantly higher mortality rate in the first year after allo-SCT (hazard ratio [HR] 3.05, 95% confidence interval [CI] 1.48-6.28, p=0.001) and led to a shorter overall survival rate (HR 1.63, 95% CI 0.86-3.10, p=0.133). However, psychological distress had no effect on hospital length of stay, hematologic recovery time, opioid usage status, or dose of opioid analgesics used. Factors associated with death after allo-SCT in the univariate analysis (p<0.05) were high-relapse risk disease, umbilical cord blood SCT, total-body irradiation-containing conditioning regimen, and higher educational background. In the multivariate analysis, high relapse risk (HR 3.85, 95% CI 1.81-8.20, p<0.001) and total-body irradiation-containing conditioning regimen (HR 3.50, 95% CI 1.29-9.51, p=0.01) were identified as risk factors for death.
Conclusion: A history of psychological distress before allo-SCT, after adjusting for other patient- and disease-related prognostic factors, had a significant influence on early death in the first year after transplantation.