title: Risk factors for depression and fatigue among survivors of hematopoietic cell transplantation.
abstract: BACKGROUND
  Patients treated with hematopoietic cell transplantation (HCT) often experience depression and fatigue but analyses to determine risk factors have typically lacked statistical power. The current study examined sociodemographic and clinical risk factors for depression and fatigue in a large cohort of survivors of HCT.
  
  
  METHODS
  Measures of depression and fatigue were included in an annual survey of HCT recipients that also included self-reported sociodemographic and health information. Patient clinical characteristics were obtained from the clinical database.
  
  
  RESULTS
  The sample consisted of 1869 recipients (with a mean age of 56 years; 53% male) who were a mean of 13 years (allogeneic recipients) and 6 years (autologous recipients) from HCT. Moderate to severe depression was reported by 13% of participants; moderate to severe fatigue was reported by 42%. Among allogeneic recipients, female sex, younger age, current presence of chronic pain, and current patient-reported severity of chronic graft-versus-host disease were found to be independently associated with greater depression whereas female sex, current presence of chronic pain, and current severity of chronic graft-versus-host disease were independently associated with greater fatigue (P values <.01). Among autologous recipients, younger age and current presence of chronic pain were found to be independently associated with both greater depression and greater fatigue (P values <.01).
  
  
  CONCLUSIONS
  Rates of depression and fatigue in this group of survivors suggest a high symptom burden. Better screening, referral, and interventions are needed.
authors.affiliation: Health Outcomes and Behavior Department, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Heather S L
authors.initials: HS
authors.lastname: Jim
authors.affiliation: Biostatistics Department, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Sutton
authors.affiliation: Health Outcomes and Behavior Department, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Jacobsen
authors.affiliation: Clinical Research Division, Fred Hutchison Cancer Research Center, Seattle, Washington.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Martin
authors.affiliation: Clinical Research Division, Fred Hutchison Cancer Research Center, Seattle, Washington.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Flowers
authors.affiliation: Clinical Research Division, Fred Hutchison Cancer Research Center, Seattle, Washington.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005221:Fatigue / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality* / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012307:Risk Factors; D057566:Self Report; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D017741:Survivors; D014184:Transplantation, Homologous / Q000009:adverse effects; D014481:United States
keywords: depression; fatigue; hematopoietic cell transplantation; neoplasms; quality of life
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