Baseline Physical and Mental Functioning Are Strong Predictors of Post-Stem Cell Transplant Function and Quality of Life.
Authors: Andorsky David J. , Lee Stephanie J. 
Published: October 2019

Abstract
Reported predictors of quality of life (QOL) after stem cell transplantation (SCT) are largely limited to biological variables. We used data from a large prospective study of autologous and allogeneic SCT recipients to test whether self-reported functioning also predicts later QOL. Surveys were collected at baseline and at 6 and 12 months following transplant and included sociodemographic variables, self-reported physical and mental functioning, and perceptions of health and recovery. Multivariate models for QOL variables at 6 and 12 months were constructed, considering baseline clinical variables (age, sex, type of transplant, disease status) and baseline QOL variables (the Short-Form 36 (SF36) physical (PCS) and mental health (MCS) scales, and a rating scale (RS)), controlling for clinical events (acute and chronic graft-vs.-host (GVHD), and relapse). Variables with p<0.05 are reported. Of 300 patients who completed baseline surveys, 197 (111 allogeneic) completed 6 month surveys, and 175 (94 allogeneic) completed 12 month surveys. Patients reporting very good or excellent health at 6 months had higher baseline health rating scales (p<.0001) and were less likely to have developed chronic GVHD (OR=.27, p=.03) or to be married/partnered (OR=.32, p=.003). Better physical health (higher PCS) at 6 months was associated with better baseline physical and mental health (p<.0001 and p=.02), and absence of acute GVHD (p<.0001) and relapse (p=.01). Baseline physical health was the strongest predictor (partial R2 =.20, model R2=.31). Better mental health (higher MCS) at 6 months was associated with better baseline mental health (p<.0001), older age (p=.049), and not being married/partnered (p=.04). Baseline mental health was the strongest predictor (partial R2 0.17, model R2=.20). At 6 months, agreement with the statement “life is back to normal” was associated with baseline health rating scale (p<0.0001); autologous SCT (p<0.0001) and being female (p=.03) were also significant. Being able to “put the illness behind and get on with life” was associated with baseline MCS (p=0.0002), having an autologous SCT (p=0.0003) and being female (p=0.02). Agreement with “I have recovered from my SCT” was associated with absence of acute GVHD (p=0.004) and higher baseline health rating scale (p=0.03). At 1 year, baseline health and functioning remained the most predictive of all QOL outcomes, even though relapse and GVHD were also significant. The negative association with being married/partnered was no longer present, and the negative association with allogeneic transplant had largely disappeared. Good risk disease was associated with lower PCS (p=.02) at 1 year, but its explanatory power in the model was far less than baseline PCS. It was not associated with any other QOL outcome. When analysis was restricted to patients who underwent allogeneic transplant, baseline physical health was predictive of physical health at 6 months (p<.0001) and 12 months (p<.0001) and baseline mental health was predictive of mental health at 6 months (p=.0006) and 12 months (p<.0001). Good disease risk was associated with being less likely to enjoy normal activities at 6 months (p=0.04) but not with any other QOL outcome. Relapse and cGVHD were associated with poorer QOL. In conclusion, baseline self-reported physical and mental health are stronger predictors of QOL after SCT than common baseline clinical predictors such as age and disease risk, independent of relapse and GVHD. </DEL>