COPING STRATEGIES AND THE QUALITY OF LIFE IN PATIENTS AFTER

AUTOLOGOUS AND ALLOGENEIC HEMATOPOIETIC STEM CEL

TRANSPLANTATIONWojnar – Gruszka K1, Krystera M2, Płaszewska – Żywko L1, Sega A1, Podstawa M1, Wojtan S1, Nowak – Kózka I3, Kózka M1

WOJNAR - GRUSZKA K.1, KRYSTERA M.2, PŁASZEWSKA - ŻYWKO L.1, SEGA A.1, WOJTAN S.1, PODSTAWA M.1, NOWAK - KÓZKA I.3, KÓZKA M.1

1CLINICAL NURSING DEPARTMENT, INSTITUTE OF NURSING AND MIDWIFERY, FACULTY OF HEALTH SCIENCES, THE JAGIELLONIAN UNIVERSITY, CRACOW,

POLAND2DEPARTMENT OF HAEMATOLOGY, THE UNIVERSITY HOSPITAL, CRACOW, POLAND

3DEPARTMENT OF ANAESTHESIOLOGY AND INTENSIVE CARE UNIT, THE UNIVERSITY HOSPITAL, CRACOW, POLAND

INTERNATIONAL SCIENTIFIC CONFERENCE „FOR HEALTHY LIVING AND CLEAR BEING“ FOR 20 YEARS FACULTY OF HEALTH SCIENCES BIRTHDAY ANNIVERSARY.

KLAIPEDA, 2019

INTRODUCTION:

Hematopoietic stem cell transplantation (HSCT) is the method most often used in the treatmentof hematopoietic neoplastic diseases. It increases the survival rate of patients and gives themchance for a complete cure.

According to Worldwide Network of Blood and Marrow Transplantation (WBMT) almost onemillion hematopoietic cell transplantations are carried out worldwide. Peripheral blood cells aremost commonly used (99% in autologous transplants and 75% in allogeneic transplants). Thenumber of transplantations increases by 10-20% annually, and the reduction of seriouscomplications contributes to the improvement of treatment results

The transplantation procedure and its effects can affect all aspects of the patient's life,determining also the quality of life (QOL). HSCT is associated with number of early and latecomplications. Problems occurring in the late period after HSCT are associated with toxicity ofhigh doses of chemotherapy and/or with conditioning treatment before transplantation as well aswith immunosuppression after transplantation.

Important factors that influence patients’ QOL are also their coping strategies. Persons taking upthe will to fight with cancer, function better in all aspects of life and better tolerate the treatmentand its possible side effects. A different prognosis is associated with the attitude of helplessness-hopelessness. The patients’ sense of control over the disease, receiving or not external support(e.g. family support) influence their coping strategies

COPING STRATEGIES AND THE QUALITY OF LIFE IN PATIENTS AFTER

AUTOLOGOUS AND ALLOGENEIC HEMATOPOIETIC STEM CELL

TRANSPLANTATION

THE AIM OF THE STUDY:

The aim of the study was to determine the relationship between coping strategies and theQOL in the patients after autologous stem cell transplantation (auto-SCT) and allogeneicstem cell transplantation (allo-SCT).

MATERIAL AND METHODS:

The study was conducted by using diagnostic survey. The FACT - BMT assessment ofquality of life questionnaire, the Scale of Mental Adaptation to Cancer Disease - Mini-MAC and the authors' questionnaire were used. The study group consisted of 60 patients,including 30 auto-SCT and 30 allo-SCT subjects in the period ≥ 3 months after theprocedure. The STATISTICA 13 program was used for statistical analysis. The significancelevel p = 0.05 was adopted.

Among the allo-SCT subjects, the largest group (46.7%)included the patients aged 27-40 years. The whole group ofauto-SCT patients consisted of persons over 41 years of age(Fig. 1).

In the group of allo-SCT patients, 50% experienced a lateform of graft versus host disease (GvHD), 23% -respiratory diseases and 17% - complications in theskeletal system (Fig 2.).

Complications in patients after auto-SCT occuredmainly in the respiratory system- 50% and skeletalsystem- 20% (Fig. 3).

RESULTS

Quality of life in patients after allo-SCT was shown tobe better than in patients after auto-SCT (p = 0.031)(Fig. 4).

In both groups, patients with a constructive style of coping with the diseaseassessed their quality of life as better than subjects who exhibiteddestructive behaviors (p = 0.01) (Fig 5., Fig. 6.).

Patients after allo-SCT were more likely to choose the "fightingspirit" strategy than those with auto-SCT (p = 0.02). The medianof the results of the other subcategories assumed similar values inboth groups (Fig. 7). Time after surgery (3-12 months and> 12months) did not affect the patients’ coping strategies, and thesubjects in both groups assessed their QOL similarly.

CONCLUSIONS:

Despite the life-threatening situation and limitations after HSCT, patients can see favorable changes

resulting from the disease, which can mainly refer to the meaning of life, the sense of greater life force

and self-confidence, changing life goals and better relationships with loved ones. The wide social

network of young people, most often subjected to allo-SCT could influence higher QOL scores in this

group. Holistic care of the patients before and after HSCT, can determine their QOL and adoption of

constructive coping strategies after transplantation.

Keywords: hematopoietic stem cell transplantation, quality of life, coping strategies.

Figure 5. Results of Spearman rank corelation between Mini-Mac Scale

and Quality of life (FACT-BMT) in a group of patients after Allo-SCT.Figure 6. Results of Spearman rank corelation between Mini-Mac Scale

and Quality of life (FACT-BMT) in a group of patients after Auto-SCT.

Figure 7. Test U Mann-Whitney graph presents the result of Mini -Mac Scale in two

different type of transplantation.

Figure 2. Late posttransplantation complications in group of patients

after allogeneic stem cel transplantation.

Figure 3. Late posttransplantation complications in group of

patients after autologous stem cel transplantation. Figure 1. Age of test group.

Figure 4. Test U Mann-Whitney graph presents the result of quality of life

(FACT-BMT) in two different type of transplantation.