After Stem Cell Transplant, Children Soon Recover Emotionally

Troy Brown

February 06, 2012

February 6, 2012 — Parents of children who undergo stem cell transplantation (SCT) might have a little less to worry about: 6 months out, most children have recovered emotionally, without signs of depression or posttraumatic stress disorder, according to a study published online February 6 in Pediatrics.

Sean Phipps, PhD, from the Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, and colleagues conducted a randomized, multisite trial on patients undergoing SCT at 4 pediatric SCT centers in the United States and Canada.

Dr. Phipps and colleagues examined whether children adjusted better long-term after SCT when additional therapies such as humor therapy and massage therapy were added to standard care, or when a parent was also provided with massage therapy and relaxation/imagery work. They found that there was no significant difference between the groups, and to their surprise, most children who had undergone SCT were at least as happy as healthy children at week 24.

"Such excellent adjustment has been reported previously in general pediatric oncology populations, but children undergoing SCT were thought to be a subgroup at higher risk of adjustment difficulties," write the authors.

Of a sample of 163 patients at baseline, 97 patients remained in the study at week 24; 25 patients had died, 11 withdrew from the study, 8 were removed from the study for medical reasons including relapse or second transplant, and 22 missed the assessment at week 24.

The child/parent dyads completed questionnaires about the child's physical health, health-related quality of life, and emotional well-being at admission and week 24. After that, patient/parent dyads were randomly assigned (stratified by age group, site, and type of transplantation) to 1 of the 3 treatment groups.

The standard-care group received typical supportive care that included aggressive pharmacologic treatment of symptoms and psychosocial support by a multidisciplinary team.

The child-only intervention group was given a 30-minute massage by a licensed massage therapist 3 times per week, from admission through the third week, in addition to standard care. This group also received humor therapy and visits from a research assistant (RA) therapist once per week.

In the child-and-parent intervention group, children received the same intervention as those in the child-only intervention group. The parent was given the same massage treatment as the child, as well as a relaxation intervention with guided imagery. Parents were provided with a relaxation CD and instructed to use it every day, as well as weekly refresher sessions with the RA therapist.

Children's Depression Inventory (CDI) scores indicated an overall reduction in depression between admission and week 24 (F, 20.8; P < .001). But, there were no significant differences between the groups (F, 0.3; P > .7), and no intervention effect was found.

At the time of admission, 5.3% of participants had CDI scores in the clinical range, and at week 24, 4.7% of participants had scores in the clinical range. In normal children, 9.6% of children have scores in the clinical range.

There was a significant reduction in posttraumatic stress syndrome from admission to week 24 (F, 21.3; P < .001), but no differences were noted between the groups (F, 0.9; P > .3), and no intervention effect was found (F, 0.8; P > .4). On admission, children's reports of posttraumatic stress syndrome were greater than historic reports by healthy children. By week 24, there were no longer significant differences between study participants and healthy children.

In all 3 groups, all subscales on the Children's Health Questionnaire were improved (all P < .05, except physical functioning [P = .08]). No differences were found between intervention groups (all P > .1), and no intervention effects were found (all P > .2).

At admission, patient reports on mental health, self-esteem, behavior, and bodily pain scores did not differ statistically from normative data (all P > .1). However, the patients did show poorer scores for physical functioning (t, −8.3; P < .001) and general health (t, −7.3; P < .001) on the Children's Health Questionnaire than normative values for healthy children. Also, although scores for physical functioning and general health improved for the patients by week 24, they remained significantly below the norm for healthy children (P < .01).

At week 24, self-esteem (t, 4.1; P < .001), behavior (t, 6.2; P < .001), mental health (t, 2.3; P = .02), and bodily pain (t, 2.6; P = .01) scores for the patients were significantly better than normal values for healthy children.

"Given that the normative response to SCT is recovery after a brief disruption, it appears that a resilience model, rather than a posttraumatic stress model, is a better fit for conceptualizing child response to SCT," the authors write.

Benefit finding in all 3 groups improved during the study (F, 16.4; P < .001). No significant differences were found between the treatment groups (F, 1.0; P > .3). At admission, scores on the Benefit Finding Scale for Children were comparable to those in a cross-section of children with cancer studied in earlier research (t, 1.1; P > .2), but they were significantly higher at week 24 (t, 4.8; P < .001).

Study limitations include a high rate of attrition and a wide age range of ages for the participants.

"The observed pattern of good adjustment and low distress during SCT is counterintuitive and contradictory to prior research, warranting further investigation about the factors that may contribute to these findings," conclude the authors.

The study was supported by the National Institutes of Health and the American Lebanese Syrian Associated Charities. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online February 6, 2012. Abstract


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