Age, Gender Among Factors Associated With Depression and Fatigue After HCT

A number of clinical and sociodemographic factors were found to be independently associated with fatigue and depression among cancer patients who were treated with hematopoietic cell transplantation (HCT), according to a new study. The factors, which differed between autologous and allogeneic transplant, included female gender, age, and graft-vs-host disease (GVHD) severity, among others.

“Not only are depression and fatigue distressing to patients, they are also associated with adverse outcomes” including non-adherence to therapy, increased mortality, and suicidal ideation, wrote study authors led by Heather S. L. Jim, PhD, of the Moffitt Cancer Center in Tampa, Florida. Previous studies examining risk factors for fatigue and depression have been hampered by small sample size and other methodological limitations.

The current study looked for those risk factors using a mailed survey in a large sample of 1,869 recipients of HCT; 1,188 of these received an allogeneic transplant, and 666 received an autologous transplant. In allogeneic patients the most common diagnoses included myeloma (39%) and non-Hodgkin lymphoma (35%), while in the autologous patients the most common diagnoses were acute leukemia (36%), chronic myeloid leukemia (28%), and myelodysplastic syndrome (10%). The results of the study were published online ahead of print in Cancer.

Among the allogeneic patients, 14% of the patients met the criteria for moderate to severe depression, 31% had moderate to severe fatigue, and 12% had both. For autologous HCT, these rates were 15%, 31%, and 12% for both. The rates of moderate to severe depression and fatigue were significantly higher among autologous HCT patients when compared with allogeneic HCT recipients from a related donor (P < .05), but not from unrelated donors.

For allogeneic HCT recipients, multivariable analysis found that female gender (P = .005), younger age (P = .002), current severity of GVHD (P < .0001), and current chronic pain (P < .0001) were independent predictors of increased depression. For fatigue, the significant predictors included female gender (P < .0001), current severity of GVHD (P < .0001), and current chronic pain (P < .0001).

For the autologous HCT patients, only younger age (P < .0001) and current chronic pain (P < .0001) were significantly associated with moderate to severe depression on multivariate analysis. The same two factors (P = .0002 for age and P < .0001 for chronic pain) were associated with fatigue.

“Results from the current study help to clarify previous mixed findings regarding risk factors for depression and fatigue,” the authors wrote. They noted that the clinical significance of GVHD and chronic pain in particular was “striking,” with significant increases in likelihood for depression and fatigue with each increase in GVHD severity or pain.

“This information can be used to guide screening decisions as well as supportive care recommendations,” the authors concluded. “Psychological screening has been shown to be feasible and to result in improved patient and provider satisfaction with care. The proactive management of symptomatology may contribute to better quality of life and other outcomes.”