Qualitative Analysis of Myeloma Patients' Experience Following Hematopoietic Stem Cell Transplant
Cognitive deficits in patients with multiple myeloma who undergo autoHSCT are not uncommon, but exercise may be beneficial.
Patients with multiple myeloma who undergo autologous hematopoietic stem cell transplant (autoHSCT) experience negative impacts on physical and cognitive functioning and may benefit from exercise throughout the transplant process, according to a study published in the European Journal of Oncology Nursing.
For this study, researchers evaluated the results of 8 qualitative studies that included outcomes for 76 patients with myeloma who received HSCT. The authors identified 4 themes throughout the course of the study.
Patients reported experiencing high levels of distress at the time between bone marrow ablation with chemotherapy and autoHSCT, a period they described as ‘feeling' or ‘being' dead. Patients were not only fearful of dying, but also stated they had ‘died'.
While experiencing difficult symptoms (eg, nausea, fatigue), patients disconnected and isolated their thoughts in an effort to protect their psychological well-being. They eliminated negative thoughts they felt could affect positive outcomes of therapy, and also disconnected themselves from friends and familial support. Patients who experienced negative physical symptoms would often internalize their frustrations and withhold information from their families.
Cognitive deficits were also frequently observed, with patients reporting that they had poor recall and issues with short term memory and concentration. Some studies found that these negative effects were permanent, and patients often struggled to even form complete sentences. Fatigue was found to contribute to cognitive impairment and associated depression.
Exercise during the transplant process, particularly exercise programs that were individualized for each patient, was found to help patients recover physically and psychologically. Some patients believed that exercising would challenge their limits and would contribute positively to their recovery.
Results of the study showed that symptom burden among this patient population is often underreported, and the authors added that nurses should engage patients frequently regarding challenges with memory, concentration, and recall. They concluded that “further research is needed on patients' longer-term experiences of cognitive impairment and the effects of exercise on overall well-being and recovery.”
Walpole G, Clark H, Dowling M. Myeloma patients' experiences of haematopoietic stem cell transplant: qualitative thematic synthesis. Eur J Oncol Nurs. 2018; 35:15-21. doi: 10.1016/j.ejon.2018.05.002