Risk of Depression and Anxiety Post Allogeneic Hematopoietic Stem Cell Transplant in Pediatric Patients with Cancer in a Low-Middle-Income Country (LMIC)

BACKGROUND: Allogeneic Hematopoietic SCT (HSCT) is a potentially curative treatment option in patients with various hematological and lymphatic malignancies. Survival after HSCT has improved over the years but despite the possibility of cure for an otherwise terminal illness, allogeneic HSCT can be accompanied by high levels of morbidity, mortality, and immense psychosocial distress. This is reflected in the significantly increased risk of psychiatric conditions previously described; for example, depression and anxiety following HSCT are reported in 5% to over 40% of patients. However, pediatric patients are not routinely assessed for these complications and the incidence in children is not well understood.

METHODS: Prospective descriptive study assessing pediatric patients undergoing allogeneic HSCT at The Children's Cancer Hospital Egypt for hematologic malignancy from January 2018 to December 2021 and alive at the time of data collection. The primary objective was to assess the prevalence and severity of anxiety and depression post allogeneic HSCT. The secondary objective was to determine potential risk factors related to anxiety and depression.

Anxiety was assessed with the Spence Children's Anxiety Scale and Beck Anxiety Inventory, while Depression was assessed with the Child Depression Inventory and Beck's Depression Inventory. Anxiety and depression were categorized into 2 categories: Non-significant with scores in the normal to mild range and not requiring medical intervention or psychotherapy and Significant with scores in the moderate to severe range and needing medical intervention and /or psychotherapy.

RESULTS: A total of 100 patients were included. The prevalence of Significant anxiety was 35% and significant depression 60%. 27% of patients had both significant anxiety and depression. Among the whole cohort, age (as a continuous variable) was the only significant predictor of anxiety, with increasing likelihood of anxiety as age decreased.

The association with gender, stem cell source, presence of GVHD and time from transplant to test were evaluated and the primary diagnosis was the only significant predictor of depression identified with AML patients having a higher risk, likely due to intensive treatment pre-transplant therapy and long admission periods.

CONCLUSION: The high prevalence of anxiety and depression post allogeneic HSCT in pediatric patients transplanted for hematologic malignancy highlights the need for routine psychological assessment as an essential component of long-term follow-up, particularly in those treated at a younger age and those with a diagnosis of AML.

KEYWORDS: Anxiety, Depression, Allogeneic Hematopoietic SCT, LMICs

No relevant conflicts of interest to declare.