Do PBSCT Patient Survivors Have Good Heath Practices?

[Guest guest]

ASH:

[1693] Preventive Health Behaviors of Stem Cell

Transplant Survivors.

J. Lee, M. Bishop, C. Odom,

A. Hahn, Kathleen A. Sobocinski, J. Doug

Rizzo, nne J. Brady, Andrykowski, Gerard

Socie, Cella, M. Horowitz, R. Wingard,

The Late Effects Committee of the IBMTR/ABMTR.

International Bone Marrow Transplant Registry

(IBMTR)/Autologous Blood and Marrow Transplant

Registry (ABMTR), Medical College of Wisconsin,

Milwaukee, WI; Medicine, University of Florida,

Gainesville, FL; Center on Outcomes Research and

Education, ton Northwestern Healthcare, ton,

IL; Behavioral Science, University of Kentucky College

of Medicine, Lexington, KY

Stem cell transplantation (SCT) is curative therapy

for many patients (pts) with acute leukemia, chronic

myelogenous leukemia (CML), lymphoma and breast

cancer. However, having survived their diseases and

transplants, it is not known how many pts participate

in healthy behaviors and currently recommended

preventive services to avoid future health problems.

We collected self-reported information on

health-preserving behaviors as part of a large,

cross-sectional study of SCT pts, spouses and

acquaintances. Results were compared to screening

recommendations from the U.S. Preventive Services Task

Force (http://odphp.osophs.dhhs.gov/pubs/guidecps/)

and infectious disease recommendations from the Center

for Disease Control

(http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4910a1.htm)

according to age, sex, and presence or absence of

chronic GVHD.

Self-reported information was classified as health

provider independent [iND] (if medical contact not

required, i.e., tobacco avoidance, exercise, and seat

belt use, reported on a 0-3 summary scale) or health

provider dependent [DEP] (e.g., cholesterol tests,

stool guaiacs, sigmoidoscopy, blood pressure check,

dental exam, breast exam, mammograms, immunizations,

colon cancer screening, reported as % compliance since

screening and preventive health recommendations vary

depending on age, sex and health status).

Access to the medical system was graded on a 0-3 scale

reflecting insurance coverage, having a physician, and

being seen in the clinic or hospital within the past

year; average scores were 2.6 for men and 2.8 for

women. 212 pts have been studied so far, 83 (39%)

allogeneic and 129 (61%) autologous recipients. 42%

had acute leukemia, 19% CML, 18% lymphoma and 20%

breast cancer. The sample is predominantly Caucasian

(89%), married (70%), female (64%), and well-educated

(74% had post high school education). Median age is 50

yrs (range 22-75 yrs), and median time since SCT is 7

yrs (range 2.7-19.5 yrs).

Only 28% of pts practiced all 3 healthy IND behaviors:

86% do not smoke, 81% always use seatbelts and 33%

often or always get the recommended amount of

exercise. Despite good access to medical care, overall

compliance with DEP behaviors was only 63%.

Screening rates were highest for breast and cervical

cancer (77-82% of women) and lowest for colon cancer

(22-32% of pts 50 yrs). In multivariable analysis,

IND behaviors were associated with higher education

(p=0.001) while greater compliance with DEP behaviors

was associated with female gender (p=0.03), higher

education (p=0.04) and autologous SCT (p=0.01). Age,

disease type, time since SCT, income, marital status

and intensity of pre-SCT chemotherapy were not

associated with compliance.

In conclusion, self-reported compliance with

recommended health behaviors in survivors of SCT

procedures is reasonably good, but there is

considerable room for improvement. Efforts to improve

general preventive screening and promote healthy

behaviors may be able to exploit SCT pts' frequent

contact with the medical system and past experience

with illness.

__________________________________________________