Impact of delirium on cognition, distress, and health-related quality of life after hematopoietic stem-cell transplantation.
OBJECTIVE
To determine the impact of delirium during the acute phase of myeloablative hematopoietic stem-cell transplantation (HSCT) on health-related quality of life (HRQOL), distress, and neurocognitive functioning 30 and 80 days after transplantation.


METHODS
Ninety patients completed a battery assessing HRQOL, distress, and neuropsychological functioning before receiving their first HSCT. Delirium was assessed three times per week using the Delirium Rating Scale and the Memorial Delirium Assessment Scale from 7 days before transplantation through 30 days after transplantation. At 30 days after transplantation, distress and neurocognitive functioning were assessed. At 80 days after transplantation, HRQOL, distress, and neuropsychological functioning were re-evaluated.


RESULTS
After adjusting for confounding factors, patients who experienced a delirium episode, versus patients who did not, reported significantly worse depression, anxiety, and fatigue symptoms at 30 days (linear regression beta(s) = 0.2, 0.3, and 0.5, respectively; P < .04). At 80 days, patients with a delirium episode had significantly worse executive functioning (beta = -1.1; P < .02), attention and processing speed (beta(s) = -4.7 and -5.4, respectively; P < .03), mental health on the Medical Outcomes Study Health Survey, 12-item short form (beta = -6.5; P < .02), and anxiety, fatigue, and cancer and treatment distress symptoms (beta(s) = 0.4, 0.6, and 0.3, respectively; P < .03).


CONCLUSIONS
Patients with a malignancy who experience delirium during myeloablative HSCT showed impaired neurocognitive abilities and persistent distress 80 days after transplantation. Effective prevention or treatment of delirium during HSCT may improve both cognitive and psychological outcomes.
Fann
Jesse R
JR
Department of Behavioral Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. fann@u.washington.edu
Alfano
Catherine M
CM
Roth-Roemer
Sari
S
Katon
Wayne J
WJ
Syrjala
Karen L
KL
D000328:Adult; D001007:Anxiety / Q000209:etiology*; D003071:Cognition; D003693:Delirium / Q000523:psychology*; D003863:Depression / Q000209:etiology*; D005221:Fatigue / Q000209:etiology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000523:psychology*; D006801:Humans; D007938:Leukemia / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life