Angela Scherwath

Cognitive function in the acute course of allogeneic hematopoietic stem cell transplantation for hematological malignancies

The aim of the study was to assess cognitive performance in patients with hematological malignancies before, and 3 months after, allogeneic hematopoietic stem cell transplant (HSCT). A consecutive sample of 39 patients was assessed before admission with a comprehensive neuropsychological test battery and health-related quality-of-life (HRQoL) questionnaires; 19 of these patients were retested around 100 days post HSCT. Test results were compared with normative data and revealed minimal differences at both time points in the level of group-means. One parameter – simple reaction time – was significantly worse (prolonged) at second measurement after HSCT. According to the definition of an impairment score (more than three impaired functions), 26% of patients were classified as impaired before as well as after HSCT. Neuropsychological test results did not vary systematically according to medical variables such as extent of pretreatment, graft-versus-host-disease (GvHD) and kind of conditioning protocol. As a dimension of HRQoL, self-rated cognitive function was in the normal range before and after HSCT. Significant correlations between HRQoL and neuropsychological parameters were related to symptom scales. This study showed impairments of neuropsychological performance for a subgroup of patients before and after allogeneic HSCT. Systematic effects of conditioning, medical variables or self-rated HRQoL could not be observed.

Sleep disturbances and emotional distress in the acute course of hematopoietic stem cell transplantation.

Recent research has shown that patients undergoing hematopoietic SCT (HSCT) experience multiple symptoms that can affect the sleep quality adversely. This study investigated the sleep quality of patient in the acute course of HSCT, and measured the impact of sociodemographic, medical, physical and psychological factors. Fifty patients were assessed before admission, 44 participated during inpatient treatment and 32 on day 100 (±20) post-transplantation. Measuring instruments included the Pittsburgh Sleep Quality Index (PSQI) and a sleep diary (sleep quality), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire—Core 30 (health-related quality of life), the Hospital Anxiety and Depression Scale—German version (anxiety/depression) and the German version of the Cancer and Treatment Distress Scale (treatment-specific distress). The prevalence of sleep disturbances was 32% before admission, 77% during the hospital stay and 28% after discharge. Difficulty in maintaining sleep was the most intense sleep problem during the inpatient phase. This was mainly caused by disturbing noises and need to use the bathroom frequently. Sleep problems were significantly worse during the hospital stay compared with the other measurement points in time (P<0.001). A significant interaction was seen between the time course of sleep disturbances and the type of transplantation (P=0.001). The findings suggest that sleep disturbances after HSCT are particularly associated with physical functioning, fatigue and treatment-specific distress, and factors that contribute to sleep difficulties in the general population seem to be less important.

Cognitive functioning in allogeneic hematopoietic stem cell transplantation recipients and its medical correlates: a prospective multicenter study.

Owing to its neurotoxicity, allogeneic hematopoietic stem cell transplantation (HSCT) carries risks for cognitive impairment. In this multicenter study, we prospectively evaluated cognitive functioning and its medical and demographic correlates in patients undergoing allogeneic HSCT.

Health-related quality of life and psychosocial consequences after mild traumatic brain injury in children and adolescents

Background: Little is known about the course of health-related quality of life (HRQOL) and functional outcome parameters in children and adolescents with TBI. In addition, a neuropsychological screening instrument would be useful for routine clinical care. Objective: To describe health-related quality of life and psychosocial consequences following mild traumatic brain injury (TBI). Methods: One chose a prospective, longitudinal design (two measurement time points). Methods included a telephone interview and a questionnaire, which was mailed to the parents whose children (older than 4 years of age) were admitted (with TBI) to a collaborating hospital. In addition, a feasibility study for screening children for cognitive side effects, attention and memory tasks was conducted. A group of 59 parents filled out questionnaires assessing health-related quality of life (KINDL), behavioural problems (SDQ) and health status (FS-II-R). Ten families participated in the feasibility study. Results: Results indicated that HRQOL, behavioural problems and health status remained stable over time. Compared to the reference groups, no significant differences in HRQOL were noted. Thirty per cent of the children screened were classified as being cognitively impaired. Conclusion: Mild TBI resulted in no decline in the childrens health outcome after injury. The cognitive screening approach proved itself to be a useful instrument for routine clinical care.

Fear of recurrence and its impact on quality of life in patients with hematological cancers in the course of allogeneic hematopoietic SCT.

We examined the course and the prevalence of a high fear of cancer recurrence (FCR) in patients undergoing allogeneic PBSC transplantation (hematopoietic SCT (HSCT)) before HSCT (N=239), 100 days after (n=150, and 12 months after allogeneic HSCT (n=102). The Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the EORTC Quality of Life Questionnaire, and the Hospital Anxiety and Depression Scale were used. Pre-HSCT 36% of patients, 100 days after HSCT 24% of patients, and 1 year after HSCT 23% of patients fulfilled the criteria for high FCR (FoP-Q-SF cutoff=34). Being married (b=2.76, P=0.026), female gender (b=4.45, P<0.001) and depression (b=4.44, P<0.001) were significantly associated with FCR at baseline. One hundred days after HSCT, depression significantly predicted FCR (b=6.46, P<0.001). One year following HSCT, female gender (b=6.61, P=0.008) and higher depression were (b=4.88, P=0.004) significant predictors for FCR. Over the three assessment points, patients with high FCR had a significantly lower quality of life compared to patients with low FCR in physical functioning (P=0.019), role functioning (P=0.003), emotional functioning (P<0.001), cognitive functioning (P=0.003), social functioning (P<0.001) and global quality of life (P<0.001). Our data provide evidence that FCR is a prevalent problem in patients with hematological malignancies and has a significant adverse impact on health-related quality of life.

Identifying children and adolescents with cognitive dysfunction following mild traumatic brain injury—Preliminary findings on abbreviated neuropsychological testing

Objective: Studies on cognitive function in paediatric patients suffering head trauma suggest neuropsychological impairment even after mild traumatic brain injury (MTBI). The present study examined the feasibility of abbreviated neuropsychological testing in different settings in children and adolescents following MTBI. Methods: Within the scope of two prospective studies on psychosocial and cognitive outcome, 71 school-aged children with mild, moderate or severe TBI were assessed. In addition, 15 healthy children were included in the study. The abbreviated instrument comprises three standardized tests measuring attention and memory functions (Digit Symbol, Digit Span, learning trials of the German Auditory Verbal Learning Test). Impairment rates were calculated according to a defined cut-off score for clinically significant cognitive impairment. Results: Abbreviated testing could easily be implemented both in the acute and post-acute clinical setting. Out of the children with MTBI, 12% (shortly after injury) and 30% (2 months after injury), respectively, were classified as cognitively impaired. Following moderate or severe TBI, impairment occurred in 50% of the patients. Healthy children showed the best performance, while children with severe TBI performed worst. Conclusion: Results suggest that abbreviated testing allows detection of MTBI-related cognitive dysfunction. Identified children should be referred to a clinical neuropsychologist for comprehensive assessment.

Cancer-and-treatment-specific distress and its impact on posttraumatic stress in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT).

In this prospective multicenter study, we investigated cancer‐and‐treatment–specific distress (CTXD) and its impact on symptoms of posttraumatic stress disorder (PTSD) in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT).

Versorgungsbedarf von Kindern und Jugendlichen mit einem Schädel-Hirn-Trauma

ZusammenfassungSchädel-Hirn-Trauma ist eine der häufigsten Ursachen für funktionelle Beeinträchtigungen im Kindes- und Jugendalter. Im Rahmen eines Projektes zur Verbesserung der ambulanten Rehabilitation und Nachsorge wurden in 4 Städten Deutschlands Beratungsstellen für betroffene Familien geschaffen. Dargestellt werden die Ergebnisse zweier Teilstudien, die zum einen auf eine Prozessanalyse der Netzwerkarbeit und zum anderen auf eine prospektive Verlaufsuntersuchung abzielten. Die Prozessanalyse basierte auf der Auswertung einer Datenbank, die für diese Studie entwickelt wurde. Mit einer prospektiven Längsschnittuntersuchung, in die zum ersten Messzeitpunkt insgesamt 103 Familien eingeschlossen werden konnten, wurden an den 4 Projektstandorten Teilnehmer zu 3 Messzeitpunkten in einem Interview und per Fragebogen befragt. Erfasst wurden die gesundheitsbezogene Lebensqualität, Inanspruchnahme und Versorgungszufriedenheit. Mit einer Unterstichprobe wurde zusätzlich ein neuropsychologisches Kurzassessment durchgeführt. Insgesamt betrachtet, kann die Lebensqualität der Kinder und Jugendlichen als gut bezeichnet werden. Es wurden kaum Gesundheitsdienste in Anspruch genommen. Eine kindgerechte Versorgung war prädiktiv für die Versorgungszufriedenheit der Eltern. Das Kurzassessment erwies sich als praktikable Methode, um Kinder und Jugendliche mit speziellem Versorgungsbedürfnis zu identifizieren.AbstractTraumatic brain injury is a leading cause of acquired disability in childhood. Within a project to improve out-patient rehabilitation and aftercare advice, centres for families affected by traumatic brain injuries were implemented in four German cities. The results of two sub-studies are described which aimed on the one hand at a process analysis of the network operation and on the other hand at a prospective analysis of the network interaction. The process analysis was based on a database which was developed for this study. Within a prospective longitudinal study, 103 families could be included. At four project sites, families were questioned with an interview and questionnaire at three different time points. Health-related quality of life, utilisation and health care satisfaction were assessed. In addition, a neuropsychological assessment was conducted with a portion of the sample. Overall, quality of life of the children and adolescents can be described as good. Health care services were scarcely utilised. A childcentred health care was predictive for the health care satisfaction of the parents. The short assessment proved to be a feasible method for identifying children and adolescents with special health care needs.Traumatic brain injury is a leading cause of acquired disability in childhood. Within a project to improve out-patient rehabilitation and aftercare advice, centres for families affected by traumatic brain injuries were implemented in four German cities. The results of two sub-studies are described which aimed on the one hand at a process analysis of the network operation and on the other hand at a prospective analysis of the network interaction. The process analysis was based on a database which was developed for this study. Within a prospective longitudinal study, 103 families could be included. At four project sites, families were questioned with an interview and questionnaire at three different time points. Health-related quality of life, utilisation and health care satisfaction were assessed. In addition, a neuropsychological assessment was conducted with a portion of the sample. Overall, quality of life of the children and adolescents can be described as good. Health care services were scarcely utilised. A childcentred health care was predictive for the health care satisfaction of the parents. The short assessment proved to be a feasible method for identifying children and adolescents with special health care needs.

Investigating the temporal course, relevance and risk factors of fatigue over 5 years: a prospective study among patients receiving allogeneic HSCT

Although allogeneic hematopoietic stem cell transplantation (HSCT) features severe physical and psychological strain, no previous study has prospectively investigated fatigue beyond 3 years after transplantation. We investigated the temporal course of fatigue over 5 years, compared patients with the general population (GP) and tested for treatment- and complication-related risk factors. Patients were assessed before conditioning (T0, N=239) and at 100-day (T1, N=150), 1-year (T2, N=102) and 5-year (T3, N=45) follow-up. We measured fatigue with the Multidimensional Fatigue Inventory-20. Patients were compared with the GP at T0 and at T3. Global fatigue increased from T0 to T1 (t=3.85, P<0.001), decreased from T1 to T2 (t=−2. 92, P=0.004) and then remained stable (t=0.45, P=0.656). No difference in global fatigue was found between T0 and T3 (t=0.68, P=0.497). Compared with the GP, patients showed higher global fatigue at T0 (t=−6.02, P<0.001) and T3 (t=−2.50, P=0.014). These differences reached meaningful effect sizes (d⩾0.5). Acute and chronic GvHD predicted global fatigue at T1 (γ=0.34, P=0.006) and T2 (γ=0.38, P=0.010), respectively. To conclude, fatigue among allogeneic HSCT patients improves with time, finally returning to pretransplantation levels. However, even after 5 years, the difference from the GP remains relevant. Patients with GvHD are at risk for increased fatigue.

Erfassung von Arbeitsengagement bei Patienten mit hämatologischen Malignomen: Die psychometrischen Eigenschaften der deutschen Version der Utrecht Work Engagement Scale 9 (UWES-9)

OBJECTIVE Our purpose was the psychometric evaluation of the German version of the Utrecht Work Engagement Scale-9 (UWES-9), a self-assessment tool measuring work-related resources consisting of 9 items. METHODS Based on a sample of 179 patients with hematological malignancies in in-patient and rehabilitative oncological settings, we tested the dimensional structure by confirmatory and explorative factor analysis. We further evaluated reliability, item characteristics, and construct validity of the UWES-9. RESULTS The confirmatory factor analysis showed acceptable fit for both a 1-dimensional factor structure and the original 3-factor model. Based on an explorative principal component analysis, we were able to replicate the 1-dimensional factor accounting for 67% of the total variance and showing very high internal consistency (α=0.94) and high factor loads (0.73-0.88). The construct validity was further supported by significant positive correlations between work engagement and meaning of work, corporate feeling, commitment to the workplace, and job satisfaction. CONCLUSION The German version of the UWES-9 shows good psychometric qualities in measuring dedication to work in patients with hematological malignancies in in-patient and rehabilitative oncological settings.