Chronic Pain, GVHD Linked With Depression Fatigue in HCT Survivors

A new study has found that 13% of survey participants who were survivors of hematopoietic cell transplantation (HCT) reported moderate to severe depression, and 42% reported moderate to severe fatigue. Both depression and fatigue were more common among survivors of allogeneic HCT who were female, were currently experiencing chronic graft versus host disease (GVHD), and had current chronic pain, according to a study published in Cancer.¹

“These data are significant because they result from what to our knowledge is one of the first well-powered studies to examine sociodemographic and clinical risk factors of depression and fatigue after HCT,” wrote researcher Heather S.L. Jim, PhD, of Moffitt Cancer Center, and colleagues. “These common and distressing symptoms are associated with adverse outcomes, including reduced quality of life and shortened survival.”

According to the researchers, early identification of patients who may be at risk for depression and fatigue could help clinicians to proactively manage these conditions, helping to improve outcomes after HCT. Studies to date have been inconsistent in identifying sociodemographic and clinical factors associated with depression and fatigue.

In this study, Dr. Jim and colleagues surveyed HCT recipients through an annual Fred Hutchinson Cancer Research Center HCT survivorship survey. The survey included self-reported sociodemographic and health information.

The final sample included 1,869 survivors who responded to the survey. For this analysis, the researchers analyzed results from survivors of allogeneic and autologous transplants separately. Results indicated that depression and fatigue were higher in the survivors of autologous transplant compared with allogeneic transplants with a related donor (P < .05).

Among the survivors of allogeneic transplant, 14% of respondents were classified as having moderate to severe depression and 31% met criteria for moderate to severe fatigue. Examination of clinical and sociodemographic factors found that sex (P = .005), age (P = .002), current severity of GVHD (P < .0001), and current chronic pain (P < .0001) were all independently associated with depression. Similarly, sex (P < .0001), current severity of GVHD disease (P < .0001), and current chronic pain (P < .0001) were all independent predictors of fatigue.

Moderate to severe depression was reported among 15% of the survivors of autologous HCT; fatigue was reported among 31%. Twelve percent of respondents met the criteria for both conditions. Again, age (P < .0001) and current chronic pain (P < .001) were independent predictors of depression, and age (P = .0002) and current chronic pain (P < .0001) were independent predictors of fatigue among these patients.

“The clinical significance of chronic GVHD and chronic pain is striking,” the researchers wrote. “Each increase in chronic GVHD severity (e.g., from mild to moderate or moderate to severe) was associated with a 90% increase in the likelihood of moderate to severe depression and a 77% increase in the likelihood of moderate to severe fatigue. The presence of chronic pain was associated with increases of > 400% in the likelihood of moderate to severe depression and fatigue in survivors of allogeneic HCT.

“Among survivors of autologous HCT, the presence of chronic pain was associated with increases of > 200% in moderate to severe depression and fatigue. These results suggest that patients reporting chronic GVHD or chronic pain are at particular risk of depression and fatigue,” the researchers wrote.

References:

1. Jim HS, Sutton SK, Jacobsen PB, et al. (2016). Risk factors for depression and fatigue among survivors of hematopoietic cell transplantation. Cancer, Jan 27. doi: 10.1002/cncr.29877.