Patient-rated emotional and physical functioning among hematologic cancer patients during hospitalization for stem-cell transplantation Predictors of anxiety and depression in hematopoietic stem cell transplant patients during protective isolation. Mental status changes after hematopoietic stem cell transplantation Therapeutic alliance in telephone-administered cognitive-behavioral therapy for hematopoietic stem cell transplant survivors. Neuropsychological and psychiatric functioning pre- and posthematopoietic stem cell transplantation in adult cancer patients: a preliminary study. Psychiatric morbidity and impact on hospital length of stay among hematologic cancer patients receiving stem-cell transplantation. Hematopoietic Cell Transplant and Use of Massage for Improved Symptom Management: Results from a Pilot Randomized Control Trial Physical and psychosocial functioning in patients undergoing autologous bone marrow transplantation – a prospective study Fatigue and physical activity in patients undergoing hematopoietic stem cell transplant. A prospective study of anxiety, depression, and behavioral changes in the first year after a diagnosis of childhood acute lymphoblastic leukemia Randomized clinical trial of telephone-administered cognitive-behavioral therapy to reduce post-traumatic stress disorder and distress symptoms after hematopoietic stem-cell transplantation. The psychometric properties of the MASC in a pediatric psychiatric sample. Does the use of the revised psychosocial assessment tool (PATrev) result in improved quality of life and reduced psychosocial risk in Canadian families with a child newly diagnosed with cancer? Development of two instruments examining stress and adjustment in children with cancer. Resilience in Children Undergoing Stem Cell Transplantation: Results of a Complementary Intervention Trial Health-related quality of life during post-induction chemotherapy in children with acute lymphoblastic leukemia in remission. Case-referent comparison of cognitive functions in patients receiving haematopoietic stem-cell transplantation for haematological malignancies: two-year follow-up results.
Summary : In this 3-year prospect i ve inpatient study , 220 patients received stem-cell transplantation ( SCT ) for hematologic cancer at a single institution . The objective of the study is to provide data on patient-rated emotional ( depression and anxiety ) and physical ( overall physical status , energy level , and systemic symptomatology ) functioning during hospitalization for SCT and to compare whether these differ between autologous and allogeneic SCT .  Patients were assessed at hospital admission ( T1 ) , day of SCT ( T2 ) , and 7 days ( T3 ) and 14 days ( T4 ) after SCT  , yielding a total of 852 evaluations . For the overall sample , anxiety was highest at T1 and decreased afterwards ; a marked worsening in physical health status variables corresponded with a sharp increase in depression from T1 to T3 , and was followed by an improvement in physical health and a reduction of depression . Compared to allogeneic SCT , a better physical outcome for autologous SCT was demonstrated by the significant group effect for systemic symptomatology and by the significant group × time interaction for overall physical status and energy level ; there were no significant differences in depression or anxiety between SCT groups . These findings have implication s for treatment decision making , coping with the transplantation process , and improving prevention and treatment strategies OBJECTIVE To examine in a sample of hematopoietic stem cell transplant patients assessed throughout protective isolation  ( i ) levels of anxiety and depression and ( ii ) pre-isolation factors ( socio-demographics , biomedical variables and personality traits ) , which might predict higher levels of anxiety and depression during isolation . METHODS The study used a longitudinal prospect i ve design . Anxiety and depression were assessed in 107 participants by the  State-Trait Anxiety Inventory and Self-rating Depression Scale  at admission and weekly at fixed time points throughout isolation . Among pre-isolation factors , patients ' psychological status was evaluated by the Cognitive Behavioral Assessment ( 2.0 ) . Predictors were explored by r and om-effects models . RESULTS One-tenth of the patients suffered from clinical ly significant anxiety and depressive symptoms at admission . Although the percentage of depressed patients increased more than twofold after 2 weeks of isolation , that of anxious patients did not significantly change over time . Female gender , higher anxiety and obsessive-compulsive symptoms , intratensive personality traits and lower performance status predicted higher depression during isolation . CONCLUSIONS Anxiety and depression represent a relevant problem for hematopoietic stem cell transplant patients during isolation . Early detection of predictors , such as anxiety levels , obsessive-compulsive symptoms and performance status , could help prevent depression via targeted psychological intervention The growing numbers of survivors of innovative cancer treatments  , such as hematopoietic stem cell transplantation ( HSCT )  , often report subsequent cognitive difficulties . The objective of this study was to evaluate and compare neurocognitive changes in patients with chronic myelogenous leukemia ( CML ) or primary myelodysplastic syndrome ( MDS ) after allogeneic HSCT or other therapies OBJECTIVE A strong therapeutic alliance has been found to predict psychotherapeutic treatment success across a variety of therapeutic modalities and patient population s. However , only a few studies have examined therapeutic alliance as a predictor of psychotherapy outcome among cancer survivors , and none have examined this relation in telephone-administered cognitive-behavioral therapy ( T-CBT ) . This study evaluated the extent to which therapeutic alliance affected psychotherapy outcomes in survivors of hematopoietic stem cell transplantation ( HSCT ) , a treatment for some cancers . METHOD Forty-six patients enrolled in a r and omized clinical trial of T-CBT for posttraumatic stress disorder ( PTSD ) completed a baseline assessment ( including self-report measures of PTSD symptoms , depression , and general distress ) , 10 individual T-CBT sessions , and follow-up assessment s at 6 , 9 , and 12 months post-baseline .  Therapeutic alliance was assessed after the 3rd T-CBT session with the Working Alliance Inventory , which yields overall and subscale ( task , bond , and goal ) scores . RESULTS Analyses revealed that higher total therapeutic alliance scores prospect ively predicted decreased depressive symptomatology ; higher task scores predicted decreased overall distress , depressive symptomatology , symptoms of re-experiencing , and avoidance ; and higher bond scores predicted decreased depressive symptomatology and symptoms of re-experiencing . CONCLUSIONS These results suggest that assessment s of therapeutic alliance should be incorporated into routine clinical care , and therapeutic alliance should be specifically cultivated in interventions to maximize psychotherapeutic benefits involving vulnerable population s such as cancer survivors The current study characterizes cognitive and psychiatric status in  hematopoietic stem cell transplantation ( HSCT ) patients shortly before and after transplant . Thirty adult patients were assessed prospect ively 1 - 2 weeks before transplantation and 100 days posttransplantation on neuropsychological and psychiatric measures . Before transplant , participants showed mild impairments on several neuropsychological measures , with the poorest performances occurring on learning and attention . Psychiatric functioning was significantly elevated compared with normative data . Significant improvements , however , were observed on neuropsychological measures by 100 days after transplant . Depression and anxiety scores also improved . C and i date s for HSCT experienced mild diffuse cognitive dysfunction and psychiatric morbidity before the procedure , but these symptoms significantly improved by 3 months following their transplant in this small sample . Education about these possible pretransplant sequelae and the potential for rebound may be helpful to patients and families as they prepare for this treatment and the recovery period PURPOSE To determine the prevalence of psychiatric disorders during hospitalization for hematopoietic stem-cell transplantation ( SCT ) and to estimate their impact on hospital length of stay ( LOS ) . PATIENTS AND METHODS In a prospect i ve inpatient study conducted from July 1994 to August 1997 , 220 patients aged 16 to 65 years received SCT for hematologic cancer at a single institution . Patients received a  psychiatric assessment  at hospital admission and weekly during hospitalization until discharge or death , yielding a total of 1,062  psychiatric interviews performed . Psychiatric disorders were determined on the basis of the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition . Univariate and multivariate linear regression analyses were used to identify variables associated with LOS . RESULTS Overall psychiatric disorder prevalence was 44.1 % ; an adjustment disorder was diagnosed in 22.7 % of patients , a mood disorder in 14.1 % , an anxiety disorder in 8.2 % , and delirium in 7.3 % . After adjusting for admission and in-hospital risk factors , diagnosis of any mood , anxiety , or adjustment disorder ( P = .022 ) , chronic myelogenous leukemia ( P = .003 ) , Karnofsky performance score less than 90 at hospital admission ( P = .025 ) , and higher regimen-related toxicity ( P < .001 ) were associated with a longer LOS . Acute lymphoblastic leukemia ( P = .009 ) , non-Hodgkin 's lymphoma ( P = .04 ) , use of peripheral-blood stem cells ( P < .001 ) , second year of study ( P < .001 ) , and third year of study ( P < .001 ) were associated with a shorter LOS . CONCLUSION Our data indicate high psychiatric morbidity and an association with longer LOS , underscoring the need for early recognition and effective treatment Background . Pediatric hematopoietic cell transplant ( HCT ) is a lifesaving treatment that often results in physical and psychological discomfort . An acupressure-massage intervention may improve symptom management in this setting . Methods . This r and omized controlled pilot trial compared a combined massage-acupressure intervention to usual care .  Children were offered three practitioner-provided sessions per week throughout hospitalization . Parents were trained to provide additional acupressure as needed . Symptoms were assessed using nurses ' reports and two question naires , the behavioral affective and somatic experiences scale and the Peds quality of life cancer module . Results . We enrolled 23 children , ages 5 to 18 . Children receiving the intervention reported fewer days of mucositis ( Hedges ' g effect size ES = 0.63 ) , lower overall symptom burden ( ES = 0.26 ) , feeling less tired and run-down ( ES = 0.86 ) , having fewer moderate/severe symptoms of pain , nausea , and fatigue ( ES = 0.62 ) , and less pain ( ES = 0.42 ) . The intervention group showed trends toward increasing contentness/serenity ( ES = + 0.50 ) and decreasing depression ( ES = −0.45 ) , but not decreased anxiety ( ES = + 0.42 ) . Differences were not statistically significant . Discussion . Feasibility of study ing massage-acupressure was established in children undergoing HCT . Larger studies are needed to test the efficacy of such interventions in reducing HCT-associated symptoms in children The main purpose of this study was to evaluate prospect ively physical and psychosocial functioning in patients with malignant blood disorders undergoing autologous bone marrow transplantation ( ABMT )  , and relate the findings to the patients ’ coping capacity . Twenty patients participated in the study before ABMT , 14 survivors at the 2–6 month follow-up and 12 at the 8–12 month follow-up . Three st and ardized question naires were used : the EORTC QLQ-C30 , the Hospital Anxiety and Depression ( HAD ) scale and the Sense of Coherence scale . No significant changes over time were found in the scores of the QLQ-C30 and HAD . Impaired social function , fatigue , dyspnea , financial problems and emotional distress were the most frequently reported deficits . Functional limitations were related to less successful coping . The results indicate that the patients in this study perceive their physical and psychosocial functioning as rather good before , as well as up to 1 year after the ABMT , as measured with the instruments used PURPOSE / OBJECTIVES To examine the patterns of fatigue , physical activity , health status , and quality of life before and after  high-dose chemotherapy and hematopoietic stem cell transplantation ( HSCT )  and to examine the feasibility of obtaining real-time fatigue and physical activity data . DESIGN Prospect i ve , repeated measures . SETTING Two midwestern academic medical centers . SAMPLE Convenience sample of autologous or allogeneic patients undergoing HSCT ( N = 20 baseline , N = 17 post-transplant ) . METHODS Subjects were assessed over a five-day period before and after HSCT for a total of 10 days . Subjects rated fatigue intensity three times daily and wore a wrist actigraph to measure physical activity .  At the end of both five-day periods , subjects completed measures of perceived health status ( European Organization for Research and Treatment of Cancer Quality of Life Question naire-Core 30 ) and life satisfaction Quality of Life Index ) . MAIN RESEARCH VARIABLES Fatigue , physical activity , perceived health status , and quality of life . FINDINGS Study results indicate that fatigue significantly increased and physical activity decreased following high-dose chemotherapy and HSCT . The decline coincided with diminished physical , emotional , role , and cognitive functioning . The symptoms that patients experienced ( i.e. , fatigue , pain , nausea and vomiting , sleep disturbances , appetite loss , and diarrhea ) increased during the acute post-transplant period . No significant changes in life satisfaction were found . CONCLUSIONS The study findings suggest that patients receiving high-dose chemotherapy followed by HSCT  experience increased fatigue , reduced physical activity , diminished functioning , and poorer quality of life immediately after transplant . Findings demonstrate that real-time fatigue and physical activity data can feasibly be collected in acutely ill patients . IMPLICATION S FOR NURSING Patients undergoing HSCT require considerable supportive nursing care immediately following transplant . Clinicians and research ers need to strive for effective symptom management to improve the likelihood of successful outcomes The authors prospect ively assessed anxiety , depression , and behavior in children with st and ard‐risk acute lymphoblastic leukemia ( SR‐ALL ) during the first year of therapy and identified associated risk factors PURPOSE A significant number of survivors of hematopoietic stem-cell transplantation ( HSCT ) report enduring adverse effects of treatment , including illness-related post-traumatic stress disorder ( PTSD ) symptoms and general distress . We report results of a r and omized clinical trial that tested the effects of a 10-session , telephone-administered cognitive-behavioral therapy ( CBT ) intervention on PTSD , depression , and distress symptoms . METHODS Survivors who had undergone HSCT 1 to 3 years earlier ( N = 408 ) were assessed for study eligibility . Those who met study eligibility criteria ( n = 89 ) completed a baseline assessment that included a clinical interview and self-report measures of PTSD symptoms ( the primary outcome ) and depression and general distress ( the secondary outcomes ) . Next , they were r and omly assigned to CBT or an assessment -only condition . Survivors in the CBT group completed 10 individual telephone-based CBT sessions ( T-CBT ) that included strategies to reduce PTSD symptoms , depression , and general distress . Follow-up assessment s occurred at 6 , 9 , and 12 months after the baseline assessment . RESULTS Linear mixed-model analyses revealed that , compared with HSCT survivors in the assessment -only condition , survivors who completed T-CBT reported fewer illness-related PTSD symptoms , including less avoidance ( P < .001 ) and fewer intrusive thoughts ( P < .05 ) as well as less general distress and fewer depressive symptoms ( P < .05 ) even after controlling for potential demographic and medical covariates . These results were consistent across the three follow-up assessment s. CONCLUSION A brief , telephone-administered CBT intervention developed for HSCT survivors is an efficacious treatment for reducing illness-related PTSD symptoms and general distress The goals of this study were twofold : to examine the psychometric properties of the  Multidimensional Anxiety Scale for Children ( MASC ) in a clinical sample of 193 children and adolescents who had received a diagnosis of major depressive or anxiety disorder , and to discriminate between these two groups of patients . Participants had volunteered in r and omized psychopharmacological clinical trials . The MASC four-factor structure was confirmed and its subscales were found to be reliable . The MASC correlated well with other self-report measures of anxiety , and less so with measures of depressive symptoms . The MASC subscales and two MASC items as well as age differentiated between anxious and depressed pediatric patients . If these results are replicated in an independent study , those items could be used by clinicians to discriminate between these two disorders . The MASC is a clinical ly useful measure to discriminate between anxious and depressed pediatric patients . Limitations due to the highly selective sample are noted OBJECTIVES Early psychosocial screening may guide interventions and ameliorate the adverse psychosocial effects of childhood cancer . The revised psychosocial assessment tool provides risk information - Universal ( typical distress ) , Targeted ( additional specific distress ) , and Clinical ( severe distress ) - about the child with cancer and his or her family . This pilot study investigated the benefits of providing a summary of family psychosocial risk information to the medical team treating the newly diagnosed child ( Experimental Group , EG ) . METHOD We conducted a pilot r and omized control trial with a sample of 67 parents , comparing the EG to the control group ( CG )  on parental perception of family psychosocial difficulties (  revised psychosocial assessment tool risk levels ) , child behavior ( behavior assessment scale for children-2 ) , pediatric quality of life ( PedsQL ) , and parental anxiety ( state-anxiety scale of the state-trait anxiety inventory ) , 2 - 4 weeks after diagnosis ( Time 1 ) and 6 months later ( Time 2 ) . RESULTS Compared to the CG , participants in the EG had significantly reduced targeted and clinical risk ( p < 0.001 ) , and improved pain related PedsQL at Time 2 ( p < 0.05 ) . Scores for PedsQL total and nearly all subscales improved over time in both groups ( p < 0.05 to p < 0.001 ) . No changes in behavior scores were noted . CONCLUSION Preliminary findings suggest that providing a summary of the Psychosocial Assessment Tool to the treating team shortly after diagnosis may help reduce family wide psychosocial risk 6 months later and improve quality of life related to pain for children who are undergoing treatment for cancer The childhood cancer literature provides limited underst and ing of the school-age child 's perception of cancer stressors and factors that contribute to adjustment in the midst of these stressors . This study evaluated the reliability and validity of two question naires : the  Childhood Cancer Stressors Inventory ( CCSI ) and the  Children 's Adjustment to Cancer Index ( CACI ) . The following steps were involved in the instrument development process : item development , face and content validation , internal consistency reliability , and construct validity . Questions for both instruments were developed from the literature and experience of the principal investigator . A panel of five expert pediatric oncology nurses was asked to evaluate the content validity of both instruments . All the experts rated every item a 4 - 5 using the content validity index , indicating that each item measured the concept addressed by the scale . Seventy-five children with cancer were asked to complete the two question naires and parents completed a demographic data sheet that included eight questions about the child 's  school attendance , performance , number of friends , and activities .  Children were 7 to 13 years of age ; 64 % were diagnosed with a leukemia/ lymphoma , and 36 % had a solid tumor .  Internal coefficient reliability for the total CCSI was .82 , and .91 for the CACI . The CCSI correlated negatively with the adjustment scale ( r = -.63 , P = 000 ) . The number of days missed from school correlated positively with the CCSI and negatively with the CACI . Children who missed more school perceived more cancer stressors and had a lower adjustment rating . Children with lower adjustment ratings on the CACI also had fewer friends ( t = 3.4(72 ) , P = .001 ) . Scores on both instruments demonstrated expected relationships with measures hypothesized to covary with the dimensions assessed by the new instruments . Adjustment issues for children with cancer have been difficult to assess because of the lack of appropriate instruments . These study findings indicate that the two new instruments can help to measure the child 's perceptions of the cancer experience BACKGROUND : Children undergoing stem cell transplantation ( SCT ) are thought to be at risk for increased distress , adjustment difficulties , and impaired health-related quality of life ( HRQL ) . We report results of a multisite trial design ed to improve psychological adjustment and HRQL in children undergoing SCT . METHODS : A total of 171 patients and parents from 4 sites were r and omized to receive a child-targeted intervention ; a child and parent intervention ; or st and ard care . The child intervention included massage and humor therapy ; the parent intervention included massage and relaxation/imagery . Outcomes included symptoms of depression and posttraumatic stress , HRQL , and benefit finding . Assessment s were conducted by patient and parent report at admission and SCT week+24 . RESULTS : Across the sample , significant improvements were seen on all outcomes from admission to week+24 . Surprisingly , patients who had SCT reported low levels of adjustment difficulties at admission , and improved to normative or better than average levels of adjustment and HRQL at week+24 . Benefit finding was high at admission and increased at week+24 ; however , there were no statistically significant differences between intervention arms for any of the measures . CONCLUSIONS : Although the results do not support the benefits of these complementary interventions in pediatric SCT , this may be explained by the remarkably positive overall adjustment seen in this sample . Improvements in supportive care , and a tendency for patients to find benefit in the SCT experience , serve to promote positive outcomes in children undergoing this procedure , who appear particularly resilient to the challenge Using a multi-attribute approach , we and others have reported on the comprehensive health status of survivors of cancer in childhood , after completion of therapy . However , there is a dearth of information about health status and associated health-related quality of life ( HRQL ) in children and adults with cancer , during the treatment process ; a deficit which this study was intended to redress . All children ( n=18 ) receiving ' maintenance ' chemotherapy for acute lymphoblastic leukemia ( ALL ) at a single institution were assessed prospect ively through a single cycle of therapy . Patients , family members and health care professionals used global ratings , the health utilities index mark 2 ( HUI2 ) and mark 3 ( HUI3 ) classification systems , and detailed descriptions of temporary states of health , to provide independent assessment s of health status at weekly intervals . Utility scores were derived for each comprehensive health state and for single attribute levels of the HUI2 system , and for the temporary health state descriptions . The classification of the subjects into the most appropriate temporary health states was challenging even for older children and some of the parents . The HUI instruments were used much more easily and produced highly comparable information . The most frequently affected attributes were pain , emotion and mobility/ambulation ; in that order . The global ( p=0.005 ) and specific morbidity burdens were , as predicted , greatest in the middle of the cycle of chemotherapy , reflecting the toxicity of steroid use . HUI2 global utility scores demonstrated moderate responsiveness with an intra-class correlation coefficient of 0.43 . Cyclical administration of therapy , in particular corticosteroids , produces important changes in health status and HRQL in children with ALL . The HUI are valid and responsive systems for quantifying the burden of morbidity during the treatment of cancer in childhood . These are sensitive tools which can be used in a wide array of other circumstances to quantify changes in health status During bone marrow or haematopoietic stem-cell transplantation ( HSCT ) , potentially neurotoxic treatments are used . Previous studies identified cognitive disturbances in patients treated with HSCT  , but prospect i ve studies with longitudinal assessment are sparse . We examined cognitive functions up to 20 months after a first baseline assessment in 101 patients undergoing HSCT and in 82 reference patients with a haematological malignancy treated with non-myeloablative cancer therapies .  Baseline findings revealed no between-group differences and demonstrated mild cognitive impairments in both groups . Follow-up analyses showed no significant changes over time , though poorer performance in attention and executive function , and psychomotor function was found in HSCT patients . Our results suggest limited HSCT-related cognitive dysfunctions . Additional follow-up is necessary to assess long-term effects
Only three multi-item and two single-item instruments were identified as being reliable and valid among pediatric cancer or HSCT patients and would therefore be appropriate to measure anxiety in this population
Purpose The primary objective was to describe anxiety measurement instruments used in children and adolescents with cancer or undergoing hematopoietic stem cell transplantation ( HSCT )  and summarize their content and psychometric properties .