Stability and priority of symptoms and symptom clusters among allogeneic HSCT patients within a 5-year longitudinal study

CONTEXT: Due to toxicity and invasiveness, allogeneic HSCT causes severe and longstanding symptom burden. Longitudinal studies on symptoms and symptom clusters (SC) would be helpful to optimize symptom control, but are rare to date.

OBJECTIVES: To investigate stability of symptoms, extract time stable SC and to determine their priority in symptom management.

METHODS: In this multicenter study, patients diagnosed with hematological cancer were assessed before conditioning (T0) and three months (T1), one year (T2) and five years (T3) after transplantation. Symptoms were assessed with the EORTC-QLQ-C30. Symptoms were stable when rated as present at three consecutive time points. Applying factor analysis, stable SC were composed of symptoms loading on the same factor across all time points. Priority in symptom management was derived from a combination of severity and predictive power for quality of life (QoL).

RESULTS: 239 patients participated at T0, 150 (63 %) at T1, 102 (43 %) at T2 and 45 (19 %) at T3. We identified three stable SC, composed of rest-tired-weak-dyspnea-loss of appetite (exhausted), tense-worried-irritable-depressed (affective) and nausea-vomiting (gastrointestinal). Fatigue was most persistent, and also most severe and predictive for QoL, both as symptom and in cluster (exhausted).

CONCLUSIONS: Given its high stability, severity and impact on QoL, fatigue should have priority in symptom management. The treatment of this symptom could be enhanced by also incorporating interventions addressing dyspnea and loss of appetite.