ALBERT

Description: Sexual dysfunction is a multidimensional problem caused by both physiologic and psychosocial factors. Yet little is known about the longitudinal trends of sexual functioning in HCT survivors, or the clinical or psychosocial factors associated with decline. Using a longitudinal study design, we administered the Derogatis Interview for Sexual Functioning (DISF-SR), the Global Sexual Satisfaction Index (GSSI), and the City of Hope-QOL instrument at 5 time points to a large cohort of patients undergoing HCT at City of Hope (COH): prior to HCT, at 6m, 1y-, 2y-, and 3y-post-HCT. DISF-SR assessed 5 domains of sexual functioning (Cognition/Fantasy, Arousal, Behavior/Experiences, Orgasm, and Drive/Relationship), and a Total score. GSSI elicited patients’ subjective appraisal of sexual satisfaction. The COH-QOL instrument was used to obtain self-reported levels of anxiety, distress, depression, pain, physical strength, and sleep changes, which were converted to composite scores of mental and physical stress. Long-term trends of sexual functions were estimated using the Generalized Estimating Equation. We examined the effects of sociodemographic factors, primary diagnosis, HCT conditioning regimens, disease status at HCT, presence of cGvHD, and composite mental and physical stress levels on the longitudinal trends of DISF-SR, the Total score, and GSSI. The cohort included 312 adults (median age at HCT 48y; 56% males) undergoing autologous (n=175) or allogeneic (n=137) HCT for hematologic malignancies or severe aplastic anemia; 144 patients completed the 3y sexual survey (participation rate at 3 years=75%). GSSI (general sexual satisfaction) declined significantly after HCT (p=0.001) for both men and women, and remained depressed over the 3-y study period, with 40% reporting poor or worse sexual satisfaction level at 3y. There were no significant differences between men and women in terms of general sexual satisfaction level. However, the degree of sexual dysfunction as measured by DISF-SR was worse in women than in men for all domains, and for Total score (p

Description: This prospective longitudinal study examined the quality of life (QOL) after hematopoietic cell transplantation (HCT) and identified risk factors of poor QOL in 312 adult autologous and allogeneic HCT patients. Physical, psychological, social, and spiritual well-being was assessed before HCT, 6 months, and 1, 2, and 3 years after HCT. For all HCT patients, physical QOL was stable from before to after HCT (P 〉 .05); psychologic (P 〈 .001), social (P 〈 .001), and spiritual (P = .03) QOL improved at 6 months. Study noncompleters (because of illness or death) had worse QOL. Allogeneic patients reported worse physical and psychologic well-being (P 〈 .05). Older patients reported worse physical but better social well-being regardless of HCT type (P 〈 .05). Two or more domains were affected by race/ethnicity, household income, and education in autologous patients, and by body mass index (BMI), decline in BMI, primary diagnosis, and chronic graft-versus-host disease (GVHD) in allogeneic patients (P 〈 .05). At 3 years, 74% of HCT patients were employed full or part time. Older autologous patients with lower pre-HCT income were less likely to work (P 〈 .05); allogeneic patients with chronic GVHD were less likely to work (P = .002). Multidisciplinary efforts to identify and support vulnerable subgroups after HCT need to be developed.

Description: The growing number of long-term HCT survivors has created the need to identify factors that could play a critical role in the survivors’ reintegration into daily life, which in turn would inform the quality of life (QOL) of the survivors. Using a longitudinal study design, we administered the City of Hope-QOL instrument to evaluate the four domains of QOL (physical, psychological, social, and spiritual well-being), as well as fatigue, anxiety, distress, and return to full-time work in a large cohort of patients undergoing HCT at City of Hope. The outcomes were evaluated before transplantation, at 6m, 1y, 2y, and 3y. Longitudinal trends for these outcomes were evaluated using the Generalized Estimating Equation method, adjusting for potential confounders such as age, race, BMI, disease. Our cohort included 313 adults (median age at HCT 48y; 56% males) undergoing autologous (n=181) or allogeneic (n=132) HCT for hematologic malignancies or severe aplastic anemia; 111 patients (65.3% of eligible) completed 3y follow-up so far. Overall, the mean scores for psychological, social, and spiritual well-being improved significantly over time compared to pre-HCT levels (p

Description: Abstract 808 The growing population of HCT survivors may be at risk for neuropsychological impairment due to exposure to neurotoxic agents. HCT survivors frequently report problems with memory and attention (Cancer 2002;95:183-192), and even though the patients are acutely aware of neuropsychological declines, these changes do not correlate well with impairment on standardized neuropsychological assessments (Bone Marrow Transplant 2005;36:695-702). This discrepancy suggests that the tests may not be sensitive enough to detect subtle changes that could nonetheless impact patients' societal reintegration, highlighting the importance of self-report instruments. The present study aims to assess the longitudinal trajectory of self-reported neuropsychological impairment in patients from pre-HCT to 1 year post-HCT; to evaluate the impact of demographic and clinical factors on self-reported neuropsychological impairment; to examine the relationship between self-reported neuropsychological impairment data and objective data collected using standardized assessments; and to understand the relationship between self-reported impairment and return to work. Participants were 182 adult patients undergoing HCT for hematological malignancies. Mean age at HCT was 50 years (range, 18-73); 60% were males; 68% were non-Hispanic whites; 62% received autologous HCT. Patients completed a 2-hour battery of standardized neuropsychological tests (domains: processing speed; immediate, general, and working memory; cognitive reserve; executive function) and a self-reported Neuropsychological Impairment Scale (NIS – scales: Global Measure of Impairment [GMI, an overall summary score], Cognitive Efficiency [COG], Attention [ATT], Memory [MEM], Learning-Verbal [L-V], Academic Skills [ACD]). Self-reported information on return to work was obtained at 6 months and 1 year after HCT. Demographic (sex, age, race/ethnicity, education, income, marital status) and clinical data (diagnosis, donor source, risk of relapse, conditioning exposures) were collected. Raw scores were converted to t-scores using normative data; individuals with t-scores above 1 SD of the normative distribution were classified as impaired. Generalized estimating equations were used to examine longitudinal trends. The prevalence of domain-specific impairment at specified time points is shown in the Table. After adjusting for significant covariates, GMI worsened at 6 months and plateaued thereafter (p=0.04) and ATT worsened at 6 months but returned to baseline at 1 year (p=0.006) (Figure). Multivariate analyses revealed the following risk factors: at pre-HCT: female gender and less than high school education (higher MEM impairment, p=0.03, p=0.05, respectively); at both 6 months and 1 year post-HCT: annual household income less than $20,000 (higher GMI impairment, p=0.02); exposure to total body irradiation (TBI: higher COG impairment, p=0.006, and higher ATT impairment, p=0.05); female gender (p=0.05) and 4-year college education (p=0.058) (higher MEM impairment). Correlations between NIS scores and standardized assessments were weak (range, r= -0.3 to 0.09). At 6 months, 57% of the patients had not returned to work. Patients with COG impairment were less likely to return to work (p=0.05), while patients with higher cognitive reserve were more likely to return to work (p=0.03). These results suggest that a significant proportion of patients undergoing HCT report neuropsychological impairment that may not be readily captured by standardized assessments. The present study identifies low household income, TBI, female gender, and college education as risk factors and describes the impact of self-reported neuropsychological impairment on the ability to return to work. This study therefore helps characterize a vulnerable population that needs to be followed closely for appropriate intervention to ensure appropriate societal reintegration after HCT.Table.Prevalence of neuropsychological impairment (t〉60) by time pointGMICOGATTMEML-VACD Pre-HCT29%33%25%25%24%22% 6 months (n=94)32%40%32%27%33%22% 1 year (n=69)32%29%23%29%25%23% Disclosures: Forman: City of Hope: Employment.