Function and Global Health
An international multicenter and multiscale study [17
] indicated that patients’ QOL was still worse than that of healthy controls 7 years after transplant, which usually involved symptoms such as sleep disturbance, physical fitness descent, fatigue, and pain. Other studies [18
] showed that most patients felt satisfied with their QOL 1 year after transplant, and 55% of patients employed prior to treatment returned full-time or part-time to their previous occupation. Even if QOL was not very good 1 year on, it would be better after 2-5 years.
From this study, we conclude that ASCT and HDCT have a significant impact on several QOL issues. Mostly, the scores were the lowest just after the transplant, and with time improved and neared the healthy controls. However, QOL was still different between patients and healthy controls at T5. Physical function reflects the status of daily activities which existed before and after ASCT and HDCT in the lives of high-risk breast cancer patients, and impairment of physical function was hard to resolve even after 5 years. Cancer patients have to accept the pain of disease, chemotherapy, transplantation, and treatment, leading to reduced physical capacity and fatigue. Some patients were worried about the disease being advanced and lost confidence to do certain daily activities. Doctors and families should encourage patients to be self-confident and exercise in order to recover physical function.
Hjermstad et al. [19
] conducted a study on QOL after transplantation that included a 1-year follow-up. In their report, they concluded that allotransplant patients had higher functional scores and less symptomatology than autologous transplant patients or the control chemotherapy patients. The patients’ emotional function was somewhat impacted by transplantation, especially in the form of anxiety and depression, with some patients requiring psychotropic drugs [20
]. During follow-up, the differences were much smaller. Our study found emotional function was worse after transplantation than before (p = 0.000); it was elevated 3 years after transplantation (p = 0.000) but still different to healthy controls after 5 years (p = 0.011). Cancer patients are always under considerable mental stress, feeling worried and anxious. However, during ASCT and HDCT, patients suffered even more tension, worry, and loneliness. With time, self-confidence improved and mental stress was relieved gradually. Many patients returned to being calm and relaxed but still required others to pay attention to them taking care of their body and mind.
Besides physical and mental health, the cancer patients faced somewhat serious social and family problems [21
]. Because of fears regarding their disease and economic pressure, patients usually experienced tension in the family, role function subsidence, and social function defects, and started avoiding responsibility. Someone needed more than 5 years to recover [22
]. Other studies [23
] indicated that most patients after transplant were satisfied with their function recovery. In this study – except for cognitive function which was damaged after transplantation and then got gradually better – role, social function, and global health of the patients were not significantly different before and after ASCT, and were similar between patients 5 years after transplant and healthy controls. We conclude that society had noted the importance of a wholesome approach to recovery of cancer patients, so these patients were respected, supported, and understood well by society. Accordingly, social communication and duties of these patients after ASCT were not notably impaired.
Symptom and Six Single Items
Fatigue was very obvious after HSCT. Most patients felt fatigue, and in 67.5% it was moderate or high. Some studies [24
] show that patients in a short period after transplantation had very obvious symptoms of fatigue which continued even 5 years after transplantation. We call this cancer-related fatigue which can be effectively improved by using psychological adjustment and behavior therapy [25
]. Other ways to relieve fatigue include easing tension, nutritional therapy, saving energy, engaging in light manual work. Medical workers should be aware of cancer-related fatigue and investigate the causes in order to take effective interventions to help patients to alleviate fatigue.
This study showed that loss of appetite and diarrhea were obvious after transplantation but improved gradually with no significant difference to healthy controls 5 years later. Therefore, patients should observe a reasonable diet during the transplantation process, and not drink or eat too much at once and avoid eating greasy or sweet foods. A reasonable diet can help patients to recover well.
Pain is one of the most important problems faced by cancer patients, which usually exists through the whole course of treatment and recovery and has a serious impact on QOL. This study also reflected this problem. Pain constantly impaired the QOL of the cancer patients before and after transplantation, and was not entirely resolved even after 5 year. Nowadays, doctors are aware of the importance of relieving pain, and many new methods and drugs have been developed. It is not only very significant to the treatment but also improves QOL.
Economic aspect, before and after transplantation, were significantly different. Economic difficulties would ease 5 years after transplantation but were still more serious than in healthy controls; 79.3% of patients thought that treatment costs caused economic difficulties. Other studies [26
] reported economic difficulties were prevalent in long-term survivors after transplantation as well as other forms of cancer or chronic diseases [27
]. With the current average standard of living in China, completing the entire treatment course would result in great economic difficulties. Patients who have basic medical insurance would bear a lesser economic burden.
Helder et al. [28
] indicated that in terms of age, gender, and some other factors, there was no difference between bone marrow transplant in childhood and in adulthood. From this test, we analyzed the correlation between the QOL and some effect factors, and concluded that age was negatively correlated with physical functions and global health, and positively correlated with fatigue and sleep disturbance. With increasing age, the patients’ physical function and global health become worse, and fatigue and insomnia become more evident. Therefore, in the course of treatment, medical workers should pay particular attention to older patients and as far as possible help them alleviate physical suffering. If necessary, drugs can be used to relieve insomnia, pain, and other symptoms.
Menopausal status has a positive correlation with emotional function, fatigue, and diarrhea. The younger patients seemed to be more sensitive when facing disease. Premenopausal women tended to be easily worried, afraid, and sensitive, and lose interest in everything. They need encouragement to return to work and recover their daily activities. Postmenopausal women suffer from the significant changes to their body, and usually feel fatigue. They should pay attention to resting and do exercises.
Tumor characteristics also had an impact on QOL. From this study, we can conclude that tumor size, stage, and ECOG score were negatively correlated with physical function and positively correlated with sleep disturbance. That is because higher-risk breast cancer patients always have a worse prognosis and suffer more physical and psychological pain and stress. In advanced-stage cancer patients that cannot recover completely, the most important thing is to elevate QOL.
In this analysis, emotional function was negatively correlated with education level. More educated patients look up information about their disease in books, the internet, and other ways, but cannot judge correctly the bulk of information they are reading. As a result, worries and anxieties increased, and they became more nervous and less confident. Medical workers should pay special attention to this patient group, patiently answer their questions, and guide them to get information through the correct channels. Psychological guidance is needed to alleviate and actively treat emotional problems.
Some studies did not find marital status and QOL to be correlated [29
] considering that the impact of being married or unmarried, or living alone or with others, was not obvious.
Results showed that marital status was positively correlated with emotional function. Those married or living with family could bear physical pain and psychological pressure better than those unmarried, widowed, or living alone. The family's understanding and encouragement would give the patient hope for survival, while being without a family's support can evoke feelings of loneliness and disappointment. Therefore, families should be offered guidance how to lift a patient's spirit and increase his/her confidence which has a significant impact on treatment completion and rehabilitation.
Economic circumstances is an important effect factor of QOL. This study shows that physical function was positively correlated with income level, and negatively correlated with the extent of economic difficulties. Therefore, with living standards and the medical insurance system improving, there will be more patients getting benefit, and QOL will be better. Meanwhile, we should pay more attention to patients without health insurance or with heavy economic burden, and try to keep medical expenses low for them and alleviate economic pressure.