title: General health, symptom occurrence, and self-efficacy in adult survivors after allogeneic hematopoietic stem cell transplantation: a cross-sectional comparison between hospital care and home care.
abstract: OBJECTIVE
  Earlier studies have shown that home care during the neutropenic phase after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is medically safe, with positive outcomes. However, there have been few results on long-term outcomes after home care. The aims of this study were to compare general health, symptom occurrence, and self-efficacy in adult survivors who received either home care or hospital care during the early neutropenic phase after allo-HSCT and to investigate whether demographic or medical variables were associated with general health or symptom occurrence in this patient population.
  
  
  METHODS
  In a cross-sectional survey, 117 patients (hospital care: n = 78; home care: n = 39) rated their general health (SF-36), symptom occurrence (SFID-SCT, HADS), and self-efficacy (GSE) at a median of 5 (1-11) years post-HSCT.
  
  
  RESULTS
  No differences were found regarding general health, symptom occurrence, or self-efficacy between groups. The majority of patients in both hospital care (77 %) and home care (78 %) rated their general health as "good" with a median of 14 (0-36) current symptoms. Symptoms of fatigue and sexual problems were among the most common. Poor general health was associated with acute graft-versus-host disease (GVHD), low self-efficacy, and cord blood stem cells. A high symptom occurrence was associated with female gender, acute GVHD, and low self-efficacy.
  
  
  CONCLUSIONS
  No long-term differences in general health and symptom occurrence were observed between home care and hospital care. Thus, home care is an alternative treatment method for patients who for various reasons prefer this treatment option. We therefore encourage other centers to offer home care to patients.
authors.affiliation: Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden, karin.bergkvist@shh.se.
authors.forename: Karin
authors.initials: K
authors.lastname: Bergkvist
authors.forename: Jeanette
authors.initials: J
authors.lastname: Winterling
authors.forename: Eva
authors.initials: E
authors.lastname: Johansson
authors.forename: Unn-Britt
authors.initials: UB
authors.lastname: Johansson
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Svahn
authors.forename: Mats
authors.initials: M
authors.lastname: Remberger
authors.forename: Jonas
authors.initials: J
authors.lastname: Mattsson
authors.forename: Joacim
authors.initials: J
authors.lastname: Larsen
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology*; D006262:Health / Q000706:statistics & numerical data*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D007938:Leukemia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012648:Self Care; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D055815:Young Adult