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Psychosocial risk predicts high readmission rates for hematopoietic cell transplant recipients

Bone Marrow Transplantation volume 53, pages 1418–1427 (2018)Cite this article

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Abstract

Hematopoietic cell transplantation (HCT) is an intensive treatment resulting in disease control however subsequent psychosocial distress is common. Screening for psychosocial risk factors that contribute to morbidity is underutilized; moreover, the value in screening is uncertain. We performed a retrospective study of 395 HCT patients who were screened for psychosocial risk using the Transplant Evaluation Rating Scale (TERS). Patients were classified by psychosocial risk as no-risk (TERS = 26.5, 52%) vs. at-risk (TERS > 26.5, 48%), with at-risk patients stratified by cumulative deficits into mild risk (TERS = 27–35.5, 39%) and moderate risk (TERS > 35.5, 9%). At-risk patients were more likely to be readmitted within 90 days (mild risk HR = 1.62, p = 0.02; moderate risk HR = 2.50, p = 0.002). Prior psychiatric history (HR = 1.81, p = 0.002) and poor coping skills (HR = 1.64, p = 0.04) also influenced readmission. At-risk patients were more likely to be readmitted for infection (no-risk = 12% vs. at-risk = 25%, p = 0.002). Pre-HCT screening with the TERS did not predict survival or length of stay although at-risk patients are at a heighted risk of readmission. Implementing strategies to reduce readmission in higher risk patients is warranted.

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Acknowledgements

Funding

This work was supported in part by the National Cancer Institute (NCI) K23 CA208010-01 (A.E.R).

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Hematology and Oncology, University of North Carolina, Chapel Hill, NC, USA

    Daniel R. Richardson

  2. Department of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH, USA

    Ying Huang, Patrick Elder, Leslie Andritsos, Don Benson, Yvonne Efebera, Sam Penza, Craig Hofmeister, Samantha Jaglowski, Sumithira Vasu, Basem William, Steven Devine & Ashley E. Rosko

  3. Department of Psychiatry, The Ohio State University, Columbus, OH, USA

    Heather L. McGinty

  4. James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA

    Joanna Newlin & Cyndi Kirkendall

  5. Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA

    William Blum & Rebecca Klisovic

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Correspondence to Daniel R. Richardson.

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Richardson, D.R., Huang, Y., McGinty, H.L. et al. Psychosocial risk predicts high readmission rates for hematopoietic cell transplant recipients. Bone Marrow Transplant 53, 1418–1427 (2018). https://doi.org/10.1038/s41409-018-0118-4

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