Predictive Value of the Psychosocial Assessment of Candidates for Transplantation (PACT) Scale in Allogeneic BMT.
Authors: McLellan Linda , Foster Larry , Rybicki Lisa , Dabney Jane , Visnosky Michele , Bolwell Brian 
Published: October 2019

Abstract
Purpose: Psychosocial risk factors have been reported to be associated with or predictive of treatment-related vulnerability and survival in allogeneic BMT. Recent survey research revealed that BMT clinicians consider psychosocial risk factors when making a decision whether or not to proceed with allogeneic BMT. The Psychosocial Assessment of Candidates for Transplantation (PACT) scale, a tool designed to study the psychosocial screening process and uniformity of decision-making in solid organ transplantation, has been utilized in BMT, but there is no research as to the relationship of the scores of psychosocial risk to medical outcomes, either in BMT or solid organ transplantation. This research analyzes the predictive value of PACT scale scores in relation to medical outcomes in allogeneic BMT.
Methods: From 11/2003 to 6/2007, 120 allogeneic BMT patients were assessed pre-transplant by oncology social workers who subsequently completed the PACT scale. The PACT scale has ratings for social support, psychological health, lifestyle factors, and understanding of transplant and follow-up. Data analyses examined relationships between the overall PACT score of a patient (ranging from low to high risk) and post-transplant medical outcomes and baseline quality of life, mood states, and coping with illness; instruments utilized to measure the latter three psychosocial variables, in order, are the Functional Assessment of Cancer Therapy scale (FACT) specific to BMT, Profile of Mood States (brief form), and Brief COPE.
Results: There is no significant relationship between risk scores on the PACT scale and shorter-term medical outcomes (i.e., length of stay, in-hospital death, death within 100 days, days until engraftment, and readmissions) nor longer-term medical outcomes (i.e., GVHD, relapse, overall survival, and relapse free survival). However, there is a significant relationship between the patient’s PACT score and pre-morbid psychosocial functioning. Lower risk PACT scores are associated with better quality of life; lower depression, anger, and confusion, higher vigor; and positive coping behaviors of self-distraction, positive reframing, and use of religion. Higher risk PACT scores are associated with negative coping behaviors of denial, substance use, and behavioral disengagement.
Conclusions: Although the PACT scale as a measure of overall psychosocial risk has been promoted as a helpful tool for the pre-transplant psychosocial evaluation process, its’ predictive value with respect to medical outcomes in BMT is arguable. However, that PACT scores associated with pre-morbid psychosocial functioning underscores the utility of the PACT scale for screening a cluster of psychosocial issues that may combine as risk factors for treatment related vulnerability. Determining patient eligibility for BMT based on overall psychosocial risk is not advisable; needed is research to further study which specific psychosocial risk factors, if any, are associated with, if not prognostic of, medical outcomes.