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      Quality of life and financial toxicity of hematopoietic stem cell transplant recipients in COVID-19 Translated title: Calidad de vida y toxicidad financiera de los receptores de trasplantes de células madre hematopoyéticas en COVID-19 Translated title: Qualidade de vida e toxicidade financeira dos transplantados de células-tronco hematopoéticas na COVID-19

      research-article
      1 , 1 , 1 , 2 , 1
      Revista Latino-Americana de Enfermagem
      Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo
      Quality of Life, Hematopoietic Stem Cell Transplantation, Bone Marrow Transplantation, Financial Stress, Financial Toxicity, COVID-19, Calidad de Vida, Trasplante de Células Madre Hematopoyéticas, Trasplante de Médula Ósea, Estrés Financiero, Toxicidad Financiera, COVID-19, Qualidade de Vida, Transplante de Células-Tronco Hematopoéticas, Transplante de Medula Óssea, Estresse Financeiro, Toxicidade Financeira, COVID-19

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          Abstract

          Objective:

          to evaluate and correlate the quality of life and financial toxicity of adult patients undergoing hematopoietic stem cell transplantation during the COVID-19 pandemic.

          Method:

          observational, analytical study, carried out with 35 patients in a reference hospital for transplantation in Latin America. For data collection, the Functional Assessment Cancer Therapy Bone Marrow Transplantation and COmprehensive Score for Financial Toxicity questionnaires were used. Spearman and Mann-Whitney correlation tests were used for data analysis.

          Results:

          general quality of life during COVID-19 had a low score (67.09/108) with greater impairment in functional well-being (14.47/28), social well-being (16.76/28) and additional concerns (23.41/40). The means of the allogeneic group were lower than those of the autologous group in all domains, showing a significant difference in relation to additional concerns (p=0.01) and in the treatment evaluation index (p=0.04). Financial toxicity was considered to have a slight impact (22.11/44). There was a relationship, albeit not significant, between quality of life and financial toxicity (p=0.051).

          Conclusion:

          the quality of life of the sample was low; there is a correlation between quality of life and financial toxicity, although not significant. The higher the financial toxicity, the lower the quality of life.

          Translated abstract

          Objetivo:

          evaluar y correlacionar la calidad de vida y la toxicidad financiera de pacientes adultos sometidos a trasplante de células madre hematopoyéticas durante el período de la pandemia de COVID-19.

          Método:

          estudio observacional, analítico, realizado con 35 pacientes en un hospital de referencia para trasplante en Latinoamérica. Para la recolección de datos, se utilizaron los cuestionarios Functional Assessment Cancer Therapy Bone Marrow Transplantation y el COmprehensive Score for financial Toxicity. Para el análisis de los datos se utilizaron las pruebas de correlación de Spearman y Mann-Whitney.

          Resultados:

          la calidad de vida general durante la COVID-19 mostró un puntaje bajo (67,09/108) con mayor deterioro en el bienestar funcional (14,47/28), bienestar social (16,76/28) y preocupaciones adicionales (23,41/40). Los promedios del grupo alogénico fueron inferiores a los del grupo autólogo en todos los dominios, presentando diferencia significativa en relación a preocupaciones adicionales (p=0,01) y en el índice de evaluación del tratamiento (p=0,04). Se consideró que la toxicidad financiera tenía un impacto leve (22.11/44). Se observó una relación, aunque no significativa, entre la calidad de vida y la toxicidad financiera (p=0,051).

          Conclusión:

          la calidad de vida de la muestra fue baja; existe una correlación entre la calidad de vida y la toxicidad financiera, aunque no significativa. Cuanto mayor es la toxicidad financiera, menor es la calidad de vida.

          Translated abstract

          Objetivo:

          avaliar e correlacionar a qualidade de vida e a toxicidade financeira dos pacientes adultos submetidos ao transplante de células-tronco hematopoéticas no período da pandemia de COVID-19.

          Método:

          estudo observacional, analítico, realizado com 35 pacientes em um hospital de referência para o transplante na América Latina. Para coleta de dados, utilizaram-se os questionários Functional Assessment Cancer Therapy Bone Marrow Transplantation e COmprehensive Score for financial Toxicity. Na análise dos dados empregaram-se os testes de correlação de Spearman e Mann-Whitney.

          Resultados:

          a qualidade de vida geral, durante a COVID-19, apresentou baixo escore (67,09/108), com maior comprometimento nas funções bem-estar funcional (14,47/28), social (16,76/28) e preocupações adicionais (23,41/40). As médias do grupo alogênico foram inferiores às do autólogo em todos os domínios, apresentando diferença significativa em relação às preocupações adicionais (p=0,01) e ao índice de avaliação do tratamento (p=0,04). A toxicidade financeira foi considerada de impacto leve (22,11/44). Observou-se relação, ainda que não significativa, entre a qualidade de vida e a toxicidade financeira (p=0,051).

          Conclusão:

          a qualidade de vida da amostra foi baixa, logo há uma correlação entre qualidade de vida e a toxicidade financeira, embora não significativa. Quanto maior a toxicidade financeira, menor a qualidade de vida.

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          Most cited references54

          • Record: found
          • Abstract: not found
          • Article: not found

          Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment

          (1998)
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            • Abstract: found
            • Article: not found

            The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient's experience.

            Cancer patients carry rising burdens of health care-related out-of-pocket expenses, and a growing number of patients are considered "underinsured." Our objective was to describe experiences of insured cancer patients requesting copayment assistance and to describe the impact of health care expenses on well-being and treatment. We conducted baseline and follow-up surveys regarding the impact of health care costs on well-being and treatment among cancer patients who contacted a national copayment assistance foundation along with a comparison sample of patients treated at an academic medical center. Among 254 participants, 75% applied for drug copayment assistance. Forty-two percent of participants reported a significant or catastrophic subjective financial burden; 68% cut back on leisure activities, 46% reduced spending on food and clothing, and 46% used savings to defray out-of-pocket expenses. To save money, 20% took less than the prescribed amount of medication, 19% partially filled prescriptions, and 24% avoided filling prescriptions altogether. Copayment assistance applicants were more likely than nonapplicants to employ at least one of these strategies to defray costs (98% vs. 78%). In an adjusted analysis, younger age, larger household size, applying for copayment assistance, and communicating with physicians about costs were associated with greater subjective financial burden. Insured patients undergoing cancer treatment and seeking copayment assistance experience considerable subjective financial burden, and they may alter their care to defray out-of-pocket expenses. Health insurance does not eliminate financial distress or health disparities among cancer patients. Future research should investigate coverage thresholds that minimize adverse financial outcomes and identify cancer patients at greatest risk for financial toxicity.
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              • Article: not found

              Clinical characteristics and outcomes of COVID-19 in haematopoietic stem-cell transplantation recipients: an observational cohort study

              Background Haematopoietic stem-cell transplantation (HSCT) recipients are considered at high risk of poor outcomes after COVID-19 on the basis of their immunosuppressed status, but data from large studies in HSCT recipients are lacking. This study describes the characteristics and outcomes of HSCT recipients after developing COVID-19. Methods In response to the pandemic, the Center for International Blood and Marrow Transplant Research (CIBMTR) implemented a special form for COVID-19-related data capture on March 27, 2020. All patients—irrespective of age, diagnosis, donor type, graft source, or conditioning regimens—were included in the analysis with data cutoff of Aug 12, 2020. The main outcome was overall survival 30 days after a COVID-19 diagnosis. Overall survival probabilities were calculated using Kaplan-Meier estimator. Factors associated with mortality after COVID-19 diagnosis were examined using Cox proportional hazard models. Findings 318 HSCT recipients diagnosed with COVID-19 were reported to the CIBMTR. The median time from HSCT to COVID-19 diagnosis was 17 months (IQR 8–46) for allogeneic HSCT recipients and 23 months (8–51) for autologous HSCT recipients. The median follow-up of survivors was 21 days (IQR 8–41) for allogeneic HSCT recipients and 25 days (12–35) for autologous HSCT recipients. 34 (18%) of 184 allogeneic HSCT recipients were receiving immunosuppression within 6 months of COVID-19 diagnosis. Disease severity was mild in 155 (49%) of 318 patients, while severe disease requiring mechanical ventilation occurred in 45 (14%) of 318 patients—ie, 28 (15%) of 184 allogeneic HSCT recipients and 17 (13%) of 134 autologous HSCT recipients. At 30 days after the diagnosis of COVID-19, overall survival was 68% (95% CI 58–77) for recipients of allogeneic HSCT and 67% (55–78) for recipients of autologous HSCT. Age 50 years or older (hazard ratio 2·53, 95% CI 1·16–5·52; p=0·020); male sex (3·53; 1·44–8·67; p=0·006), and development of COVID-19 within 12 months of transplantation (2·67, 1·33–5·36; p=0·005) were associated with a higher risk of mortality among allogeneic HSCT recipients, and a disease indication of lymphoma was associated with a higher risk of mortality compared with plasma cell disorder or myeloma (2·41, [1·08–5·38]; p=0·033) in autologous HSCT recipients. Interpretation Recipients of autologous and allogeneic HSCT who develop COVID-19 have poor overall survival. These data emphasise the need for stringent surveillance and aggressive treatment measures in HSCT recipients who develop COVID-19. Funding American Society of Hematology; Leukemia and Lymphoma Society; National Cancer Institute; National Heart, Lung and Blood Institute; National Institute of Allergy and Infectious Diseases; National Institutes of Health; National Cancer Institute; Health Resources and Services Administration; Office of Naval Research.
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                Author and article information

                Contributors
                Role: Concepción y dibujo de la pesquisaRole: Obtención de datosRole: Análisis e interpretación de los datosRole: Redacción del manuscritoRole: Revisión crítica del manuscrito en cuanto al contenido intelectual importante
                Role: Análisis e interpretación de los datosRole: Análisis estadístico Role: Redacción del manuscrito Role: Revisión crítica del manuscrito en cuanto al contenido intelectual importante
                Role: Análisis e interpretación de los datosRole: Análisis estadísticoRole: Redacción del manuscritoRole: Revisión crítica del manuscrito en cuanto al contenido intelectual importante
                Role: Análisis e interpretación de los datosRole: Análisis estadísticoRole: Redacción del manuscritoRole: Revisión crítica del manuscrito en cuanto al contenido intelectual importante
                Role: Concepción y dibujo de la pesquisaRole: Análisis e interpretación de los datosRole: Análisis estadísticoRole: Redacción del manuscritoRole: Revisión crítica del manuscrito en cuanto al contenido intelectual importante
                Journal
                Rev Lat Am Enfermagem
                Rev Lat Am Enfermagem
                rlae
                Revista Latino-Americana de Enfermagem
                Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo
                0104-1169
                1518-8345
                18 September 2023
                Jan-Dec 2023
                : 31
                : e3995
                Affiliations
                [ 1 ]Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brasil.
                [ 2 ]Universidade Federal do Paraná, Departamento de Estatística, Curitiba, PR, Brasil.
                Author notes
                [Autor de correspondencia: ] Natália Naome Oshiro E-mail: natalia.oshiro@ 123456hc.ufpr.br https://orcid.org/0000-0002-8290-4796

                Conflicto de intereses: los autores han declarado que no existe ningún conflicto de intereses.

                Editor Asociado: Maria Lucia do Carmo Cruz Robazzi

                Author information
                http://orcid.org/0000-0002-8290-4796
                http://orcid.org/0000-0002-5985-7418
                http://orcid.org/0000-0002-6706-1233
                http://orcid.org/0000-0002-9852-6777
                http://orcid.org/0000-0003-4868-8193
                Article
                00357
                10.1590/1518-8345.6688.3995
                10508220
                37729248
                df8e4394-f383-4d4f-8522-8c000136bbb8
                Esta licencia permite a otros distribuir, mezclar, ajustar y construir a partir de su obra, incluso con fines comerciales, siempre que le sea reconocida la autoría de la creación original. Esta es la licencia más servicial de las ofrecidas. Recomendada para una máxima difusión y utilización de los materiales sujetos a la licencia.

                Este es un artículo de acceso abierto distribuido bajo los términos de la Licencia Creative Commons CC BY.

                History
                : 27 January 2023
                : 30 June 2023
                Page count
                Figures: 3, Tables: 9, References: 43
                Categories
                Artículo Original

                quality of life,hematopoietic stem cell transplantation,bone marrow transplantation,financial stress,financial toxicity,covid-19,calidad de vida,trasplante de células madre hematopoyéticas,trasplante de médula ósea,estrés financiero,toxicidad financiera,qualidade de vida,transplante de células-tronco hematopoéticas,transplante de medula óssea,estresse financeiro,toxicidade financeira

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