SAN DIEGO--Researchers at the Fred Hutchinson Cancer Research Center,
Seattle, have been monitoring the institutions transplant
patients for quality of life (QOL) for more than two decades, Keith
Sullivan, MD, of the Department of Medical Oncology, said at the
Sixth International Symposium on Recent Advances in Hematopoietic
Stem Cell Transplantation, sponsored by the University of California,
More than 2,500 Hutchinson transplant patients are actively being
followed in several ways, he said.
On-site examinations are conducted at the first transplant
anniversary and various anniversaries thereafter. The exams include
detailed medical, hematologic, and immunologic evaluations.
Questionnaires are sent to referring physicians at 6 months and then
at each anniversary.
Patients are sent a questionnaire each year that asks questions about
functional performance, symptoms, and medical complications.
With this system, Dr. Sullivan said, all but 4% to 8% of surviving
patients have been contacted for updates within the last 2 years.
While recent studies of former transplant patients have reported that
most survivors do relatively well, many of these cross-sectional
studies have been limited by such things as a follow-up of less than
5 years, limited scope, and small sample size. Hutchinson researchers
have tried to fill in this gap.
One study, headed by Dr. Nigel Bush, scrutinized the quality of life
of long-term transplant survivors. Participants in the study had
survived a mean of 10 years since transplantation. Some had their
transplant as far back as 18 years ago. Of the 125 patients, 87% had
an allogeneic transplant and the rest autologous. One measurement
used in the study was a 270-item survey that took patients about 90
minutes to complete.
Overall, the news from this research was quite good. "In
general, the severity of complaints was low," Dr. Sullivan
observed. "Eighty percent listed their current quality of life
as good to excellent, while 5% listed it as poor."
Although there were lingering complaints of such problems as fatigue,
sexual dysfunction, and sleep disturbances, most survivors considered
these to be of low severity, and 88% said the benefits of transplant
outweighed the side effects.
Return to Normal Functioning
In another Hutchinson study, Dr. Karen Syrjala and colleagues
prospectively analyzed 67 adults before and after allogeneic
transplantation. Physical function was most impaired at 90 days after
transplant, and most patients had returned to their normal
functioning by 1 year. Two years after transplantation, 68% had
returned to full-time work, and only 9% still had not done so by the
fourth transplant anniversary.
Before the transplant, 27% of patients complained of depression,
while 41% experienced anxiety. These numbers did not change the first
year after the transplant. Persons who were single or had experienced
family conflict before the cancer were more likely to experience
greater emotional distress a year after transplantation. A patient
was more likely to bounce back if he or she enjoyed a strong family