Hematopoietic cell transplantation (receipt of bone marrow transplant or stem cells transplant) is an effective and widely used treatment for hematologic malignancies, according to background information in the article. The rate and predictors of physical and emotional recovery after HCT have not been adequately defined in long-term studies. Improved understanding of recovery could facilitate more accurate informed consent, permit better planning by patients, families, and medical teams, and enable the design of interventions to improve functional recovery.
Karen L. Syrjala, Ph.D., of the Fred Hutchinson Cancer Research Center, Seattle, and colleagues conducted a study to examine recovery of physical and mental health and return to work after HCT for treatment of leukemia or lymphoma. Patient function was assessed from pretransplantation to 5-year follow-up for 319 adults who had myeloablative (bone marrow suppression) HCT for treatment of leukemia or lymphoma. Of the 99 long-term survivors who had no recurrent malignancy, 94 completed 5-year follow-up.
The researchers found that physical recovery occurred earlier than psychological or work recovery. Only 19 percent of patients recovered on all outcomes at 1 year. The proportion without major limitations increased to 63 percent by 5 years.
"Results of this prospective longitudinal study show that recovery after HCT occurs gradually over 1 to 5 years as measured by improvement in physical function, return to work, depression, and treatment-related distress. Given adequate time, 84 percent of survivors returned to full-time work. At some point during treatment or recovery, 22 percent of the patients had symptoms consistent with clinical depression while an additional 31 percent had mild depressive symptoms. Higher levels of depression, lower levels of physical function, and less satisfaction with social support before HCT increased the risk of impaired physical and emotional recovery after the transplantation. Women had increased risk for depression, treatment-related distress, and delayed return to full-time work. Conversely, previous experience with chemotherapy or radiation therapy before beginning HCT seemed to facilitate recovery from the psychological aspects of this intensive treatment," the authors write.
"These results are both encouraging and cautionary. Patients, families, and medical teams depend on accurate recovery data when planning for posttransplant needs. Expectations that contradict actual experience cause stress for survivors and potential conflicts with family, work, and the medical team. To facilitate realistic planning, clinicians and patients should understand that full recovery requires more than a year for most survivors. Patients at risk for delayed recovery can be identified before transplantation. Rehabilitation programs, similar to those that have accelerated recovery for cardiac patients, might improve the physical and psychological health of HCT recipients and other patients who have survived after curative treatment for cancer," the researchers conclude. (JAMA. 2004; 291:2335-2343. Available post-embargo at JAMA.com)
Editor's Note: This work was supported by grants from the National Cancer Institute.
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JAMA