Late effects and healthcare needs of survivors of allogeneic stem cell transplantation: a qualitative study
- 1Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- 2Department of English, University of Houston-Downtown, Houston, Texas, USA
- 3Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
- Correspondence to Jessica P Hwang, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1465, Houston, Texas 77030, USA;
Purpose This qualitative study of survivors of allogeneic stem cell transplantation (SCT) for haematological malignancy explored attitudes about late effects of therapy, healthcare issues and information needs.
Methods We conducted 12 indepth cognitive interviews and three focus groups of patients who had previously had SCT and were without recurrence of their primary disease. We used grounded theory methods, where themes emerged from consensus between cocoders. Health-related quality of life was assessed with the short-form 36 (SF-36).
Results The study included 22 patients (50% female; 95% white; mean age 47 years). The mean time from SCT was 5.2 years (±1.4 years). Most had low SF-36 scores. Participants discussed late effects of therapy, most commonly graft-versus-host disease, and how they impacted their quality of life. They reported frequent healthcare use and cancer screening after SCT and discussed problems affording care and interacting with insurance companies. Participants shared sources of health information (eg, preferring providers as their primary sources of information, but also learnt from websites, medical journals and peer experiences) and identified information barriers (eg, feeling ‘on their own’ insofar as they did not have targeted care for their needs), and expressed importance of anticipatory guidance regarding infertility. Overall, participants' personal issues and social influences impacted survivors' needs and attitudes.
Conclusions SCT survivors face continuing and lasting health effects. The factors impacting survivorship needs are complex and may be interrelated. Future research should study the affect of incorporating personal and social issues into existing clinical SCT programmes on survivors' quality of life.
Funding This study was funded by the Lamar Fleming Trust and O.H. Davenport Fund, endowments of the Texas Medical Center. Dr. Hwang is a recipient of a National Cancer Institute Career Development Award (K07 CA132955). Dr. Suarez-Almazor holds a K24 Midcareer Investigator Award from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (K24 AR053593).
Competing interests None.
Ethics approval Ethics approval is provided by the University of Texas MD Anderson Cancer Center. All participants provided informed consent.
Provenance and peer review Not commissioned; externally peer reviewed.
- Accepted 3 July 2012.
- Published Online First 2 August 2012
- Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions