Coping and modifiable psychosocial factors are associated with mood and quality of life in patients with chronic graft-versus-host-disease (GVHD)

Abstract Introduction Chronic graft-versus-host-disease (GVHD) is one of most common complications following allogeneic hematopoietic cell transplantation (HCT) and the most significant contributor to morbidity and non-relapse mortality. The physical burdens and psychosocial difficulties of these patients have not been systematically described. An exploration into the rates and correlates of mood and quality of life (QOL) in patients with chronic GVHD is necessary to develop a clinically-relevant, evidence-based intervention to promote well-being. Methods From 7/2015 to 7/2017, adult allogeneic HCT survivors with established moderate to severe chronic GVHD (N=52) enrolled in a prospective, longitudinal study at a tertiary academic center. We examined the rates and correlates of depression and anxiety symptoms (Hospital Anxiety and Depression Scale), and explored whether constructs including coping strategies (Coping Inventory for Stressful Situations), symptom burden (Lee Symptom Assessment Scale), physical functioning (Human Activity Profile), and perceived social support (Medical Outcomes Study Social Support Survey) predicted QOL trajectory over time (Functional Assessment of Cancer Therapy-Bone Marrow Transplant) at baseline, three-, and six-months follow-up. Analyses adjusted for age, sex, chronic GVHD severity, and time since chronic GVHD diagnosis. Results At the baseline, three-, and six-month follow-up, 32.7%, 31.1%, and 37.8% of patients reported clinically significant depression symptoms, and 30.8%, 20.0%, and 36.4% reported clinically elevated anxiety symptoms, respectively. Adjusting for covariates, greater use of negative emotion-oriented coping ( β =0.20, p =.002), less use of task-oriented coping ( β =-0.10, p= .021), worse physical functioning ( β =-0.07, p= .004), and higher symptom burden ( β =0.07, p= .002) were independently associated with depression symptoms at baseline. Greater use of negative emotion-oriented coping ( β= 0.28, p 001) and worse physical functioning ( β= -0.05, p= .034) were independently associated with anxiety at baseline. Patients that used more negative emotion-oriented coping ( β =-0.58, p= .035), less task-oriented ( β =0.40, p= .028) and social diversion-oriented coping ( β= 0.35, p= .039), and had higher symptom burden ( β= -0.30, p= .001), worse physical functioning ( β= 0.32, p .001), and lower perceived social support ( β =6.47, p= .003) at baseline reported poorer QOL over time. Conclusions The unmet physical and psychosocial needs of patients with chronic GVHD are substantial and warrant investigation into evidence-based interventions that may improve QOL and mood by targeting modifiable psychosocial constructs identified in this study.