A new study shows that psychosocial risk factors that impact a person's ability to cope with chronic stress are associated with significantly higher readmission rates and longer hospital stays among blood cancer patients undergoing hematopoietic stem cell transplantation (HSCT).
Researchers at The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James) noted this is a critical clinical concern and area of unmet need for patients who require intensive treatment to eradicate their cancer that should be addressed in a systematic way by the oncology community.
"Stem cell transplant can be a curative treatment for certain cancers, but it is a very long process that can put strains on a patient before, during, and after the actual transplant," said Ashley Rosko, MD, an OSUCCC-James hematologist and senior author of the new study. "Just like we assess potential impact and risks of a patient's co-morbidities before pursuing a stem cell transplant, we saw a need to evaluate psychosocial vulnerabilities to identify those patients at the highest risk for complications and develop interventions to ensure the smoothest recovery possible."
Study Design & Results
The goal of this study was to identify patients who might be at increased risk for complications during or after treatment based on non-traditional medical factors that influence overall health and well-being, such as depression and anxiety.
Researchers conducted an observational study of 395 patients undergoing stem cell transplant to treat acute leukemia, multiple myeloma, lymphoma, and other cancers/disorders at the OSUCCC-James in Columbus, Ohio.
Prior to treatment, all patients in this study had a psychosocial screening to identify factors affecting their ability to cope including history of anxiety, depression, substance abuse, health behaviors, family social support, emotional tone, and mental status. Patients deemed at-risk were subcategorized into mild and moderate risk.
OSUCCC-James researchers found that 48 percent of all patients included in this observational study were deemed to be at risk. Psychiatric conditions (24%), poor health behaviors (16%), and poor coping history (13%) were the most common identified risk factors.
In addition, all patients with any degree of psychosocial vulnerability-regardless of race, disease type, remission status, or type of stem cell transplant procedure-were at a higher risk for hospital readmission following HSCT and at-risk autologous transplant patients have a significantly longer length of stay.
"Hospital readmission in stem cell transplant patients is associated with poor overall survival, increased cost, and worse quality of life so it is important that we do all that we can to identify these patients in advance of treatment to help them successfully navigate the treatment process," noted Rosko. "Many of these psychosocial risk factors can be mitigated and managed to the benefit of the patient."
Researchers expect to continue this research through a prospective study aimed at identifying at-risk patients prior to therapy and offering a psychologist-led coping strategy intervention prior to treatment.
"We need to help our patients better cope with the chronic stress of a cancer diagnosis and treatment so they are less likely to have setbacks in care due to additional illness," Rosko concluded.
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