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Impact of Delirium on Cognition, Distress, and Health-Related Quality of Life After Hematopoietic Stem-Cell Transplantation

Jesse R. Fann, Catherine M. Alfano, Sari Roth-Roemer, Wayne J. Katon, Karen L. Syrjala

From the Departments of Biobehavioral Sciences and Public Health Sciences, Fred Hutchinson Cancer Research Center; Departments of Psychiatry and Behavioral Sciences, Epidemiology, and Health Services Research, University of Washington, Seattle, WA; College of Public Health and Comprehensive Cancer Center, Ohio State University, Columbus, OH; and Arizona Medical Psychology, Scottsdale, AZ

Address reprint requests to Jesse R. Fann, MD, MPH, Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington, 1959 NE Pacific St, Seattle, WA 98195-6560; e-mail: fann{at}u.washington.edu

Purpose: To determine the impact of delirium during the acute phase of myeloablative hematopoietic stem-cell transplantation (HSCT) on health-related quality of life (HRQOL), distress, and neurocognitive functioning 30 and 80 days after transplantation.

Patients and Methods: Ninety patients completed a battery assessing HRQOL, distress, and neuropsychological functioning before receiving their first HSCT. Delirium was assessed three times per week using the Delirium Rating Scale and the Memorial Delirium Assessment Scale from 7 days before transplantation through 30 days after transplantation. At 30 days after transplantation, distress and neurocognitive functioning were assessed. At 80 days after transplantation, HRQOL, distress, and neuropsychological functioning were re-evaluated.

Results: After adjusting for confounding factors, patients who experienced a delirium episode, versus patients who did not, reported significantly worse depression, anxiety, and fatigue symptoms at 30 days (linear regression ßs = 0.2, 0.3, and 0.5, respectively; P < .04). At 80 days, patients with a delirium episode had significantly worse executive functioning (ß = –1.1; P < .02), attention and processing speed (ßs = –4.7 and –5.4, respectively; P < .03), mental health on the Medical Outcomes Study Health Survey, 12-item short form (ß = –6.5; P < .02), and anxiety, fatigue, and cancer and treatment distress symptoms (ßs = 0.4, 0.6, and 0.3, respectively; P < .03).

Conclusion: Patients with a malignancy who experience delirium during myeloablative HSCT showed impaired neurocognitive abilities and persistent distress 80 days after transplantation. Effective prevention or treatment of delirium during HSCT may improve both cognitive and psychological outcomes.

Supported by Grant No. RPG-97-035-01-PBR from the American Cancer Society and by a grant from the University of Washington Royalty Research Fund. Also supported by Grant No. CA92408 from the National Cancer Institute (C.M.A.) and, in part, by Grants No. CA63030, CA78990, and CA112631 from the National Cancer Institute (K.L.S.).

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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