Baseline patient-reported outcomes (PROs) are associated with both healthcare utilization and risk of acute graft-versus-host disease (GVHD) in allogeneic hematopoietic stem cell transplantation recipients, according to data presented at December's American Society of Hematology virtual meeting.
In this exclusive MedPage Today video, study author Patrick Connor Johnson, MD, of Massachusetts General Cancer Center in Boston, discusses the findings.
Following is a transcript of his remarks:
My name is Connor Johnson from the Massachusetts General Hospital Cancer Center. Thank you so much for the chance to talk a little bit about our work, looking at baseline patient-reported outcomes and their association with complications of hematopoietic stem cell transplant or HCT.
As a way of some background, HCT is an important therapy that can be curative in a significant number of hematologic malignancies. Despite this, it can be associated with significant toxicities and complications as well as intensive health care visits. We've also seen in a number of areas of oncology that patient-reported outcomes have grown and their importance and prior work has demonstrated the feasibility of collecting patient-reported outcomes in HCT patients. Despite this, the relationship of patient-reported outcomes at baseline and actual healthcare utilization and complications of HCT remains unknown. So we sought to evaluate the association of baseline patient report outcomes health utilization and complications of transplant.
To address this, we did a secondary analysis of 250 patients from two supportive care trials conducted at Massachusetts General Hospital in 2011 to 2016. The patients in our study were all adult patients, 18 years or older, who had a hematologic malignancy diagnosis, and either underwent autologous or allogeneic transplant. They had to be able to complete study questionnaires with the patient-reported outcomes.
We collected these patient-reported outcomes within 72 hours of the transplant admission. And we looked at quality of life as well as fatigue and depression and anxiety symptoms at baseline.
In respect to outcomes, we looked at healthcare utilization, including the rates of hospitalization in the first hundred days after transplant and the number of days alive and out of the hospital in the first hundred days after transplant. For complications, we focused on the allogeneic transplant population and looked at acute GVHD in the first hundred days post-transplant as well as chronic GVHD in the first year post-transplant.
Our analysis relied on looking at logistic regression or Poisson regression depending upon the appropriate outcome. And we controlled for important patients as well as clinical factors. In respect to patient characteristics I want to highlight, the median age of patients was 60 years; the majority of patients had a performance status of zero or one; and the HCT comorbidity index was a median score of three. About half of patients, 55.6%, had an allogeneic transplant. And the most common diagnosis overall was acute myeloid leukemia.
We actually looked at allogeneic transplant recipient characteristics. The majority of patients had a matched unrelated donor transplant and received tacrolimus and methotrexate for GVHD prophylaxis. The most common BRAF source was peripheral blood. In respect to the main findings of the study, baseline anxiety was associated with a greater likelihood of hospitalization in the first hundred days post-transplant, despite controlling for a number of other patient and clinical factors. In respect to days alive and out of hospital in the first hundred days, baseline fatigue scorer, in other words higher fatigue, was associated with a lower number of days alive and out of the hospital.
In respect to complications of transplant, specifically acute graft versus host disease, we found that baseline quality of life, baseline depression, and baseline fatigue scores were all associated with the likelihood of acute graft versus host disease. No factors were associated with the likelihood of chronic graft versus host disease.
So a few major takeaways that I want to mention from our study. First, fatigue, and anxiety are associated with the intensity of healthcare use in autologous and allogeneic transplant recipients. And quality of life, depression, and fatigue are associated with a likelihood of acute graft versus host disease in allogeneic transplant recipients.
In total, these findings support continuing to try and integrate routine collection of patient-reported outcomes and clinical practice, and that supportive care interventions in rehabilitation programs may be useful targets of research to try and improve post-transplant outcomes. Thank you so much for your time.
Greg Laub joined MedPage Today in 2005 as Production Manager and led the launch of the video department in 2007. He is currently responsible for the website's video production. Follow
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