Self-reported depression, anxiety lead to poorer outcomes for patients with chronic GVHD

Depression or symptoms of anxiety significantly compromised quality of life and physical function and worsened disease burden among patients with chronic graft-versus-host disease, according to findings presented at the BMT Tandem Meetings.

Self-reported depression also appeared associated with lower OS in this cohort.

Areej R. El-Jawahri, MD

“This work identifies a highly vulnerable population of hematopoietic stem cell transplant survivors with chronic GVHD and significant psychological distress who may benefit from intense monitoring and interventions to improve their symptoms and outcomes,” Areej R. El-Jawahri, MD, assistant in medicine at Massachusetts General Hospital and instructor in medicine at Harvard Medical School, told HemOnc Today.

Chronic graft-versus-host disease (GVHD) is a major cause of morbidity and mortality among patients who undergo allogeneic transplant; however, the impact of psychological distress on patients with chronic GVHD in relation to quality of life, functional status and symptom burden had been unknown.

El-Jawahri and colleagues compare chronic GVHD outcomes between patients with and without psychological distress.

The analysis included data from 481 patients from the Chronic GVHD Consortium — a prospective, observational multicenter cohort — who had answered the depression question on the chronic GVHD symptom assessment scale.

Overall, 19.3% of the patients (n = 93; 46.5% women) reported being moderately or extremely bothered by depression. Twenty-three percent (n = 110; 46.3% women) reported moderate or extreme anxiety, and an additional 14% reported being bothered by depression and anxiety.

Diagnoses in the cohort who reported depression or anxiety included acute myeloid leukemia/myelodysplastic syndrome (depression, 44.9%; anxiety, 46.3%), lymphoma (depression, 26.7%; anxiety, 25.1%), acute lymphoblastic leukemia (depression, 11.2%; anxiety, 12.3%) and other (depression, 17.1%; anxiety, 16.3%). The severity of the chronic GVHD was moderate in most patients (depression, 51.3%; anxiety, 52.2%).

Compared with patients without depression or anxiety, those with these symptoms tended to have a younger median age (depression, 48.3 years vs. 51 years; P = .01; anxiety, 47.8 years vs. 51.4 years; P = .001).

Results of a multivariable analysis showed patients with self-reported depression had a worse quality of life (beta = –3.8; 95% CI, –6 to –1.6), higher disease symptom burden (beta = 8.83; 95% CI, 6.2-11.5) and worse functional status (beta = –43.9; 95% CI, –67.9 to –18).

Further, having depression symptoms appeared associated with poorer OS (HR = 1.41; 95% CI, 1.01-1.95) compared with patients without depression symptoms. However, there was no difference in nonrelapse mortality (HR = 1.17; 95% CI, 0.75-1.82).

Similarly, patients reporting anxiety also had a lower quality of life (beta = –3.71; 95% CI, –5.8 to –1.6), higher disease burden (beta = 9.72; 95% CI, 7.24-12.2) and worse functional status (beta = –38.37; 95% CI, –63.3 to –13.5). However, anxiety did not lead to worse OS (HR = 1.31; 95% CI, 0.78-2.21) or nonrelapse mortality (HR = 1.12; 95% CI, 0.72-1.71).

The researchers identified several study limitations, including that the cohort was primarily composed of non-Hispanic white patients and that depression and anxiety were self-reported.

The researchers also noted that there are inherent potential confounders with an observational study, and that they were unable to determine a temporal relationship or causality.

The next steps in this area of research would be to explore the temporal relationships between psychological distress, chronic GVHD symptom burden and functional status with structural equation models and to develop psychological interventions that target the needs of this population, according to the researchers. – by Anthony SanFilippo

Reference:

El-Jawahri A, et al. Abstract 10. Presented at: BMT Tandem Meetings; Feb. 18-22, 2016; Honolulu, Hawaii.

For more information:

Areej R. El-Jawahri, MD, can be reached at areej_el-jawahri@dfci.harvard.edu.

Disclosure: HemOnc Today was unable to confirm the researchers’ relevant financial disclosures at the time of reporting.