Evaluación de la calidad de vida después de tres años del trasplante de células madre hematopoyéticas

Marques, Angela da Costa Barcellos; Machado, Celina Angélica Mattos; Tomim, Dabna Hellen; Guimarães, Paulo Ricardo Bittencourt; Felix, Jorge Vinicius Cestari; Kalinke, Luciana Puchalski

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/1980-220X-REEUSP-2020-0270 copiar

Evaluación de la calidad de vida después de tres años del trasplante de células madre hematopoyéticas

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Evaluar los dominios de la calidad de vida relacionada con la salud de pacientes con cáncer hematológico en los tres primeros años después del trasplante de células madre hematopoyéticas autólogo y alogénico.

Método:

Cohorte prospectivo realizado de septiembre 2013 a febrero 2019 en un servicio de referencia en Latinoamérica con 55 participantes. Se utilizaron los instrumentos Quality of Life Questionnaire Core C30 y Functional Assessment Cancer Therapy – Bone Marrow Transplantation. Para el análisis de datos, se utilizó el Generalized Linear Mixed Model.

Resultados:

Los dominios de calidad de vida global y general presentaran las menores puntuaciones en la etapa de pancitopenia: 59,3 y 91,4 en el autólogo, 55,3 y 90,3 en el alogénico. El análisis de métodos mixtos demostró que hubo un cambio significativo en la puntuación entre las etapas durante el tratamiento (p< 0,05).

Conclusión:

La calidad de vida relacionada con la salud presentó cambios significativos en los dominios entre las etapas a lo largo del tiempo. Conocer estos resultados posibilita intervenciones de enfermería direccionadas a los dominios afectados durante el tratamiento.

DESCRIPTORES
Calidad de Vida; Trasplante de Células Madre Hematopoyéticas; Trasplante de Médula Ósea; Neoplasias Hematológicas; Enfermería Oncológica

Quality of Life Questionnaire – Core 30 (QLQ – C30)
Scores	*Pre-HSCT^ Notes: HSCT: Hematopoietic stem-cell transplant; † Aut: Autologus; ‡ Alo: Allogeneic; §QOL: quality of life. n = 55*		Pancytopenia n = 50		Pre-discharge n = 49		Post HSCT 100 days n = 41		Post HSCT 180 days n = 38		Post HSCT 360 days n = 32		Post HSCT 2 years n = 25		Post HSCT 3 years n = 22
	Means SD		Means SD		Means SD		Means SD		Means SD		Means SD		Means SD		Means SD
	Aut^† Notes: *HSCT: Hematopoietic stem-cell transplant; † Aut: Autologus; ‡ Alo: Allogeneic; §QOL: quality of life. n = 16	Alo^‡ Notes: *HSCT: Hematopoietic stem-cell transplant; † Aut: Autologus; ‡ Alo: Allogeneic; §QOL: quality of life. n = 39	Aut^† Notes: *HSCT: Hematopoietic stem-cell transplant; † Aut: Autologus; ‡ Alo: Allogeneic; §QOL: quality of life. n = 16	Alo^‡ Notes: *HSCT: Hematopoietic stem-cell transplant; † Aut: Autologus; ‡ Alo: Allogeneic; §QOL: quality of life. n = 34	Aut^† Notes: *HSCT: Hematopoietic stem-cell transplant; † Aut: Autologus; ‡ Alo: Allogeneic; §QOL: quality of life. n = 16	Alo^‡ Notes: *HSCT: Hematopoietic stem-cell transplant; † Aut: Autologus; ‡ Alo: Allogeneic; §QOL: quality of life. n = 33	Aut^† Notes: *HSCT: Hematopoietic stem-cell transplant; † Aut: Autologus; ‡ Alo: Allogeneic; §QOL: quality of life. n = 13	Alo^‡ Notes: *HSCT: Hematopoietic stem-cell transplant; † Aut: Autologus; ‡ Alo: Allogeneic; §QOL: quality of life. n = 28	Aut^† Notes: *HSCT: Hematopoietic stem-cell transplant; † Aut: Autologus; ‡ Alo: Allogeneic; §QOL: quality of life. n = 12	Alo^‡ Notes: *HSCT: Hematopoietic stem-cell transplant; † Aut: Autologus; ‡ Alo: Allogeneic; §QOL: quality of life. n = 26	Aut^† Notes: *HSCT: Hematopoietic stem-cell transplant; † Aut: Autologus; ‡ Alo: Allogeneic; §QOL: quality of life. n = 11	Alo^‡ Notes: *HSCT: Hematopoietic stem-cell transplant; † Aut: Autologus; ‡ Alo: Allogeneic; §QOL: quality of life. n = 21	Aut^† Notes: *HSCT: Hematopoietic stem-cell transplant; † Aut: Autologus; ‡ Alo: Allogeneic; §QOL: quality of life. n = 7	Alo^‡ Notes: *HSCT: Hematopoietic stem-cell transplant; † Aut: Autologus; ‡ Alo: Allogeneic; §QOL: quality of life. n = 18	Aut^† Notes: *HSCT: Hematopoietic stem-cell transplant; † Aut: Autologus; ‡ Alo: Allogeneic; §QOL: quality of life. n = 4	Alo^‡ Notes: *HSCT: Hematopoietic stem-cell transplant; † Aut: Autologus; ‡ Alo: Allogeneic; §QOL: quality of life. n = 18
*Global QOL^§ Notes: HSCT: Hematopoietic stem-cell transplant; † Aut: Autologus; ‡ Alo: Allogeneic; §QOL: quality of life.**	70.8 16.3	79.2 17.8	59.3 19.2	55.3 20.9	73.9 15.1	66.7 20.6	80.7 13.3	71.4 23.7	75.6 21.4	77.5 20.1	72.7 16.7	70.6 22.7	63.1 28.8	77.7 16.4	75.0 21.5	82.8 13.8
Funtional Scale
Physical functioning	72.9 22.3	77.9 21.8	50.8 21.4	57.6 19.5	57.5 22.4	68.2 18.4	82.5 14.2	74.7 21.1	79.4 20.7	80.5 23.7	83.6 17.7	83.8 16.6	60.9 32.5	85.7 20.3	68.3 23.9	80.3 26.2
Role functioning	79.1 30.1	79 29.5	50 36	41.1 26.3	52 37.4	61.6 29.3	82 24	72.6 26.9	88.8 21.7	77.5 31.9	90.9 20.2	87.3 20.3	61.9 41.6	86.1 26.3	70.8 34.3	85.1 28.5
Emotional functioning	70.8 19.9	65.1 25.5	71.8 19.6	70.5 24	77.6 20.3	68.6 30.6	85.9 9.2	74 24.9	81.9 12.7	72.1 25.2	71.9 17.9	67.4 33.4	52.3 25.3	69.4 26.5	52 38.7	67.1 25.8
Cognitive functioning	81.2 18.3	84.1 21.9	85.4 19.1	74 16.6	91.6 18.2	83.3 24.6	91 12.9	82.1 29	91.6 11.2	80.7 21.9	83.3 23.57	80.9 28	61.9 36.9	84.2 25.8	70.8 25	82.4 23.2
Social functioning	62.5 33.6	52.1 31.1	46.8 29.3	33.3 31.5	46.8 28	35.8 35.3	71.7 32.1	52.9 40	86.1 18.5	67.9 36.7	81.8 26.3	75.4 29.6	59.5 40.6	85.1 22	66.6 40.8	79.6 33.1

Functional Assessment of Cancer Therapy Bone Marrow Transplantation (FACT-BMT).
Scores	Pre-HSCT^* Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries). n = 55*		Pancytopenia n = 50		Pré-high n = 49		Post HSCT 100 days n = 41		Post HSCT 180 days n = 38		Post HSCT 360 days n = 32		Post HSCT 2 years n = 25		Post HSCT 3 years n = 22
	Means SD		Means SD		Means SD		Means SD		Means SD		Means SD		Means SD		Means SD
	Aut^† Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; *TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries). n = 16	Alo^‡ Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; *TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries). n = 39	Aut^† Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; *TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries). n = 16	Alo^‡ Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; *TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries). n = 34	Aut^† Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; *TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries). n = 16	Alo^‡ Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; *TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries). n = 33	Aut^† Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; *TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries). n = 13	Alo^‡ Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; *TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries). n = 28	Aut^† Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; *TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries). n = 12	Alo^‡ Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; *TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries). n = 26	Aut^† Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; *TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries). n = 11	Alo^‡ Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; *TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries). n = 21	Aut^† Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; *TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries). n = 7	Alo^‡ Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; *TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries). n = 18	Aut^† Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; *TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries). n = 4	Alo^‡ Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; *TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries). n = 18
Overall QV^§ Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; *TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries). FACT-BMT	107.7 18.3	108.6 22.2	91.4 16.4	90.3 14.6	98.9 16.6	95 16.6	114.8 20.2	105 18.8	115.3 21	111.1 22.2	113.8 20.2	109.7 19	101.8 30.6	117.1 16.1	95.3 41.3	117.7 20.1
Physical well-being	21 5.9	22.3 6	16.4 4.9	14.5 6.3	19.9 5	18.7 6.3	23 4	21.2 5.4	23.9 3.7	22.7 6.4	24.2 2.5	23.4 5.4	17.1 10.4	24.8 3.5	19.5 8.7	24.1 5.7
Social and family well-being	20.8 6.9	21.1 4.4	17 6.5	18.6 4.3	16.7 6.7	17.6 4.69	19.9 7.9	20.1 5.2	20.8 5.7	21.2 5.9	20.7 7.9	19.7 4.4	21.5 4.8	21.6 3.1	16.8 11.3	21.3 4.1
Emotional well-being	19.4 4	17.7 4.4	20.1 2.9	19.5 3.7	20.5 3.1	19.7 3.8	21.3 2.2	19.8 3.2	20.7 2.3	19.4 4.1	19.1 3.1	19.1 3.7	15.5 6.1	20.2 3	17 4.5	19.9 4.6
Functional well-being	18.9 6	19.5 5.3	15.1 5.1	14.6 4.1	16.9 4.1	15.4 4.2	20.2 5.3	16.2 5.1	18.6 6	18.6 5.3	19.9 5	18.2 4	17.4 7.1	19.3 3.9	16 9.4	20.9 4.4
Additional worries	27.5 4.1	27.9 6.8	22.6 4.6	23 4.2	24.7 4.6	23.4 4.2	30.3 4.6	27.4 5.2	31.1 5.7	29 6	29.9 5.6	29.1 6.2	30.1 6.8	31 5.6	26 10.4	31.3 5
TOI^** Notes: HSCT: hematopoietic stem cell transplant; †Aut: Autologus; ‡Alo: Allogeneic; §QOL: quality of life; *TOI – Index for the assessment of treatment result (physical well-being/functional well-being/additional worries).	67.4 13.5	69.7 15.9	54.2 13.1	52.1 11.9	61.6 12.3	57.6 12.2	73.6 12.6	64.9 12.7	73.7 14.5	70.4 15.8	74 12.4	70.8 12.9	64.7 21.3	75.3 12	61.5 27.7	76.4 13.8
FACTG^†† ††FACTG – Overall assessment (physical well-being/family and social well-being/emotional well-being/functional well-being).	80.2 15.4	80.7 16.5	68.8 12.7	67.3 11.8	74.2 12.8	71.5 13.1	84.4 16.2	77.5 14.5	84.1 15.8	82 16.9	83.9 16	80.5 14.4	71.6 26.2	86.1 11.3	69.33 32	86.3 15.3

Factors	QLQ-C30^* Notes: Quality of Life Questionnaire-Core 30; †Functional Assessment of Cancer Therapy Bone Marrow Transplantation; ‡QOL = Quality of Life; §F = F Snedecor statistics; p < 0.05. Global QOL^‡ Notes: Quality of Life Questionnaire-Core 30; †Functional Assessment of Cancer Therapy Bone Marrow Transplantation; ‡QOL = Quality of Life; §F = F Snedecor statistics; **p < 0.05.		FACT-BMT^† Notes: Quality of Life Questionnaire-Core 30; †Functional Assessment of Cancer Therapy Bone Marrow Transplantation; ‡QOL = Quality of Life; §F = F Snedecor statistics; p < 0.05. Overall QOL^‡ Notes: Quality of Life Questionnaire-Core 30; †Functional Assessment of Cancer Therapy Bone Marrow Transplantation; ‡QOL = Quality of Life; §F = F Snedecor statistics; **p < 0.05.
Factors	F^§ Notes: Quality of Life Questionnaire-Core 30; †Functional Assessment of Cancer Therapy Bone Marrow Transplantation; ‡QOL = Quality of Life; §F = F Snedecor statistics; *p < 0.05.	p ^** Notes: Quality of Life Questionnaire-Core 30; †Functional Assessment of Cancer Therapy Bone Marrow Transplantation; ‡QOL = Quality of Life; §F = F Snedecor statistics; *p < 0.05.	F^§ Notes: Quality of Life Questionnaire-Core 30; †Functional Assessment of Cancer Therapy Bone Marrow Transplantation; ‡QOL = Quality of Life; §F = F Snedecor statistics; *p < 0.05.	p ^** Notes: Quality of Life Questionnaire-Core 30; †Functional Assessment of Cancer Therapy Bone Marrow Transplantation; ‡QOL = Quality of Life; §F = F Snedecor statistics; *p < 0.05.
Intercept	1362.54	0.00	1713.83	0.00
Groups	0.25	0.61	0.12	0.72
Phases	6.18	0.00^** Notes: Quality of Life Questionnaire-Core 30; †Functional Assessment of Cancer Therapy Bone Marrow Transplantation; ‡QOL = Quality of Life; §F = F Snedecor statistics; *p < 0.05.	12.45	0.00^** Notes: Quality of Life Questionnaire-Core 30; †Functional Assessment of Cancer Therapy Bone Marrow Transplantation; ‡QOL = Quality of Life; §F = F Snedecor statistics; *p < 0.05.
Groups/Phase	1.65	0.12	2.22	0.03

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[1] Corresponding author: Luciana Puchalski Kalinke, Av. Pref. Lothario Meissner, 632 Bloco Didático II, 3º andar, 80210-170 – Curitiba, PR, Brazil, kalinkeluciana@gmail.com