Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Quality of Life

Acute health-related quality of life in children undergoing stem cell transplant: I. Descriptive outcomes

Bone Marrow Transplantation volume 29, pages 425–434 (2002)Cite this article

Abstract

There has been little empirical documentation of the acute effects of bone marrow or stem cell transplant (BMT) on children. In the present study, the responses of 153 children undergoing BMT were assessed in a prospective, longitudinal design. Children were assessed at the time of admission for transplant, then underwent weekly assessments to week +6, followed by monthly assessment to month +6. Data were obtained both by parent report and patient report (for patients age 5 and up) using the BASES scales. The major findings are: (1) children undergoing BMT enter the hospital with an already heightened level of distress (defined by high levels of somatic symptoms and mood disturbance, and low levels of activity) that increases dramatically following conditioning, reaching a peak approximately 1 week following transplant; (2) this increased distress is transient, declining rapidly back to admission levels by week +4 to week +5, followed by a further decline to presumed basal levels by months 4–6; and (3) the trajectories of distress depicted by both parent and child report are remarkably similar, each providing confirmatory support for the validity of the findings. These findings confirm a number of widely held clinical impressions that had not previously been documented empirically, and point to the need for new interventions or more intensive approaches to supportive care aimed at reducing levels of distress during the acute phase of transplant.

Bone Marrow Transplantation (2002) 29, 425–434. doi:10.1038/sj.bmt.1703377

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Andrykowski M . Pyschiatric and social aspects of bone marrow transplantation Psychosomatics 1994 35: 13 24

    Article  CAS  PubMed  Google Scholar 

  2. Phipps S, Barclay D . Psychosocial consequences of pediatric bone marrow transplantation Int J Pediatr Hematol/Oncol 1996 3: 171 182

    Google Scholar 

  3. Wettergren L, Langius A, Bjorkholm M, Bjorvell H . Physical and psychosocial functioning in patients undergoing autologous transplantation – a prospective study Bone Marrow Transplant 1997 20: 497 502

    Article  CAS  PubMed  Google Scholar 

  4. Leigh S, Wilson KCM, Burns R, Clark RE . Psychosocial morbidity in bone marrow transplant recipients: a prospective study Bone Marrow Transplant 1995 16: 635 640

    CAS  PubMed  Google Scholar 

  5. Sasaki T, Akaho R, Sakamaki H et al. Mental disturbances during isolation in bone marrow transplant patients with leukemia Bone Marrow Transplant 2000 25: 315 318

    Article  CAS  PubMed  Google Scholar 

  6. Hjermstad MJ, Loge JH, Evensen SA et al. The course of anxiety and depression during the first year after allogeneic or autologous stem cell transplantation Bone Marrow Transplant 1999 24: 1219 1228

    Article  CAS  PubMed  Google Scholar 

  7. Rodrigue JR, Graham-Pole J, Kury S et al. Behavioral distress, fear, and pain among children hospitalized for bone marrow transplantation Clin Transplant 1995 9: 454 456

    CAS  PubMed  Google Scholar 

  8. Gunter M, Karle M, Werning A, Klingbiel T . Emotional adaptation of children undergoing bone marrow transplantation Can J Psychiatry 1999 44: 77 81

    Article  CAS  PubMed  Google Scholar 

  9. Syrjala KL, Chapko MK, Vitiliano PP et al. Recovery after allogeneic marrow transplantation: prospective study of predictors of long-term physical and psychosocial functioning Bone Marrow Transplant 1993 11: 319 327

    CAS  PubMed  Google Scholar 

  10. Andrykowski MA, Brady MJ, Greiner CB et al. ‘Returning to normal’ following bone marrow transplantation: outcomes, expectations, and informed consent Bone Marrow Transplant 1995 15: 573 581

    CAS  PubMed  Google Scholar 

  11. McQuellon RP, Russell GB, Rambo TD et al. Quality of life and psychological distress of bone marrow transplant receipients: the ‘time trajectory’ to recovery over the first year Bone Marrow Transplant 1998 21: 477 486

    Article  CAS  PubMed  Google Scholar 

  12. Parsons SK, Barlow SE, Levy SL et al. Health-related quality of life in pediatric bone marrow transplant survivors: according to whom? Int J Cancer Suppl 1999 12: 46 51

    Article  CAS  PubMed  Google Scholar 

  13. McConville BJ, Steichen-Asch P, Harris R et al. Pediatric bone marrow transplants: psychological aspects Can J Psychiatry 1990 35: 769 775

    Article  CAS  PubMed  Google Scholar 

  14. Garber J, Walker LS, Zeman J . Somatization symptoms in a community sample of children and adolescents: further validation of the Children's Somatization Inventory Psychol Assess 1991 3: 588 595

    Article  Google Scholar 

  15. McGrath PJ . There is more to pain measurement in children than ‘ouch’ Can Psychol 1996 37: 63 75

    Article  Google Scholar 

  16. McConaughy SH . Advances in empirically based assessment of children's behavioral and emotional problems School Psychol Rev 1993 22: 285 307

    Google Scholar 

  17. Phipps S, Hinds PS, Channell S, Bell G . Measurement of behavioral, affective, and somatic responses to pediatric bone marrow transplantation: Development of the BASES scale J Pediatr Oncol Nurs 1994 11: 109 117

    Article  CAS  PubMed  Google Scholar 

  18. Phipps S, Dunavant M, Jayawardene D, Srivastiva D . Assessment of health-related quality of life in acute in-patient settings: use of the BASES instrument in children undergoing bone marrow transplantation Int J Cancer Suppl 1999 12: 18 24

    Article  CAS  PubMed  Google Scholar 

  19. Spieth LE, Harris CV . Assessment of health-related quality of life in children and adolescents: an integrative review J Pediatr Psychol 1996 21: 175 193

    Article  CAS  PubMed  Google Scholar 

  20. Testa MA, Simonson DC . Assessment of quality of life outcomes New Engl J Med 1996 334: 835 840

    Article  CAS  PubMed  Google Scholar 

  21. Phipps S, Decuir-Whalley S . Adherence issues in pediatric bone marrow transplantation J Pediatr Psychol 1990 15: 459 475

    Article  CAS  PubMed  Google Scholar 

  22. Hollingshead AB . Four Factor Index of Social Status Yale University Press: New Haven, CT 1975

    Google Scholar 

  23. Diggle PJ, Liang KY, Zeger SL . Analysis of Longitudinal Data Oxford University Press: New York 1994

    Google Scholar 

  24. SAS Institute, Inc. SAS OnlineDoc, Version 8 SAS Institute Inc: Cary, NC 1999

  25. Lipsitz SR, Kim K, Zhao L . Analysis of repeated categorical data using generalized estimating equations Stat Med 1994 13: 1149 1163

    Article  CAS  PubMed  Google Scholar 

  26. Fairclough DL, Peterson HF, Chang V . Why are missing quality of life data a problem in clinical trials of cancer therapy? Stat Med 1998 17: 667 677

    Article  CAS  PubMed  Google Scholar 

  27. Qian W, Parmar MKB, Sambrook RJ et al. Analysis of messy data from a randomized clinical trial Stat Med 2000 19: 2657 2674

    Article  CAS  PubMed  Google Scholar 

  28. Fairclough DL, Peterson HF, Cella D, Bonomi P . Comparison of several model-based methods for analysing incomplete quality of life data in cancer clinical trials Stat Med 1998 17: 781 796

    Article  CAS  PubMed  Google Scholar 

  29. Sullivan AK, Szkrumelak N, Hoffman LH . Psychological risk factors and early complications after bone marrow transplantation in adults Bone Marrow Transplant 1999 24: 1109 1120

    Article  CAS  PubMed  Google Scholar 

  30. Phipps S, Brenner M, Heslop H et al. Psychological effects of bone marrow transplantation on children: preliminary report of a longitudinal study Bone Marrow Transplant 1995 16: 829 835

    Google Scholar 

  31. Phipps S, Mulhern RK . Family cohesion and expressiveness promote resilience to the stress of pediatric bone marrow transplant: a preliminary report Dev Behav Pediatr 1995 16(4): 257 263

    Google Scholar 

  32. Vannatta K, Zeller M, Noll RB, Koontz K . Social functioning of children surviving bone marrow transplantation J Pediatr Psychol 1998 23: 169 178

    Article  CAS  PubMed  Google Scholar 

  33. Barrera M, Pringle LAB, Sumbler K, Saunders F . Quality of life and behavioral adjustment after pediatric bone marrow transplantation Bone Marrow Transplant 2000 26: 427 435

    Article  CAS  PubMed  Google Scholar 

  34. Stuber M, Nader K, Yasuda P et al. Stress responses following pediatric bone marrow transplantation: preliminary results of a prospective longitudinal study J Am Acad Child Adolesc Psychiatry 1991 30: 952 957

    Article  CAS  PubMed  Google Scholar 

  35. Butler R, Rizzi L, Handwerger B . The assessment of post-traumatic stress disorder in pediatric cancer patients and survivors J Pediatr Psychol 1996 21: 499 504

    Article  CAS  PubMed  Google Scholar 

  36. Stuber M, Kazak A, Meeske K, Barakat L . Is posttraumatic stress a viable model for understanding responses to childhood cancer? Child Adolesc Psychiatry Clin NAm 1998 7: 169 182

    Article  CAS  Google Scholar 

  37. Achenbach TM, McConaughy SH, Howell CT . Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity Psychol Bull 1987 101: 213 232

    Article  CAS  PubMed  Google Scholar 

  38. Klein RG . Parent–child agreement in clinical assessment of anxiety and other psychopathology: a review J Anxiety Dis 1991 5: 187 198

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported in part by grant R29 CA60616 from the National Cancer Institute, and by the American Lebanese and Syrian Associated Charities (ALSAC).

Author information

Authors and Affiliations

  1. Divisions of Behavioral Medicine, St Jude Childrens Research Hospital, Memphis, TN, USA

    S Phipps, M Dunavant & PA Garvie

  2. Division of Biostatistics, St Jude Childrens Research Hospital, Memphis, TN, USA

    S Lensing & SN Rai

Authors
  1. S Phipps
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Dunavant
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. PA Garvie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S Lensing
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. SN Rai
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Phipps, S., Dunavant, M., Garvie, P. et al. Acute health-related quality of life in children undergoing stem cell transplant: I. Descriptive outcomes. Bone Marrow Transplant 29, 425–434 (2002). https://doi.org/10.1038/sj.bmt.1703377

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1703377

Keywords

This article is cited by

Search

Advanced search

Quick links