Multivariate analysis of sociodemographic and clinical factors in relation to poor psychological outcomes among HCT survivors
| . | Anxiety . | Depression . | Somatization . | Global distress . | ||||
|---|---|---|---|---|---|---|---|---|
| OR (95% CI) . | P . | OR (95% CI) . | P . | OR (95% CI) . | P . | OR (95% CI) . | P . | |
| Sex | ||||||||
| Female | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Male | 1.02 (0.56-1.86) | .95 | 1.80 (1.14-2.85) | .01 | 0.89 (0.60-1.31) | .55 | 1.09 (0.68-1.76) | .71 |
| Race/ethnicity | ||||||||
| Non-Hispanic white | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Others | 1.94 (0.98-3.87) | .06 | 1.28 (0.75-2.18) | .36 | 1.60 (0.99-2.60) | .05 | 2.04 (1.17-3.55) | .01 |
| Education | ||||||||
| Did not complete HS/HS graduate | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Some college or above | 0.62 (0.31-1.21) | .16 | 0.64 (0.38-1.09) | .10 | 1.26 (0.75-2.11) | .38 | 0.81 (0.46-1.43) | .47 |
| Household income, $ | ||||||||
| > 60 000/y | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| 20 000-60 000/y | 3.28 (1.41-7.59) | .01 | 2.12 (1.21-3.71) | .01 | 1.92 (1.21-3.05) | .01 | 2.04 (1.11-3.74) | .02 |
| < 20 000/y | 3.22 (1.08-9.64) | .04 | 3.10 (1.56-6.19) | < .001 | 2.28 (1.23-4.24) | .01 | 2.54 (1.21-5.35) | .01 |
| Health insurance | ||||||||
| Yes | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| No | 0.87 (0.31-2.43) | .80 | 1.16 (0.59-2.32) | .66 | 1.20 (0.61-2.37) | .60 | 1.35 (0.66-2.78) | .42 |
| Marital status | ||||||||
| Married | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| No | 0.82 (0.42-1.59) | .55 | 1.45 (0.88-2.37) | .14 | 1.02 (0.65-1.57) | .95 | 1.28 (0.76-2.17) | .35 |
| Health status | ||||||||
| Excellent/good | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Fair/poor | 3.80 (2.03-7.12) | < .0001 | 3.56 (2.20-5.74) | < .0001 | 5.58 (3.71-8.39) | < .0001 | 5.98 (3.65-9.81) | < .0001 |
| Chronic health condition | ||||||||
| None | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Grade1/2 | 1.36 (0.68-2.73) | .39 | 1.48 (0.88-2.48) | .14 | 1.44 (0.91-2.28) | .12 | 1.21 (0.70-2.10) | .49 |
| Grade3/4 | 1.39 (0.57-3.38) | .47 | 1.49 (0.76-2.90) | .24 | 1.91 (1.09-3.36) | .02 | 1.37 (0.68-2.74) | .38 |
| Risk of relapse at HCT | ||||||||
| Standard risk | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| High risk | 1.18 (0.64-2.20) | .59 | 0.75 (0.46-1.21) | .23 | 0.95 (0.63-1.43) | .81 | 0.77 (0.46-1.28) | .31 |
| Age at HCT, year (per 10 y) | 0.91 (0.70-1.20) | .52 | 0.80 (0.66-0.98) | .03 | 0.98 (0.82-1.17) | .86 | 0.88 (0.71-1.09) | .25 |
| Time since HCT (per 10 y) | 0.62 (0.29-1.29) | .20 | 0.55 (0.32-0.93) | .03 | 0.56 (0.35-0.92) | .02 | 0.56 (0.31-0.99) | .05 |
| Primary cancer diagnosis | ||||||||
| CML | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| AML/ALL | 1.32 (0.60-2.92) | .49 | 1.19 (0.69-2.08) | .53 | 0.94 (0.57-1.54) | .79 | 0.92 (0.50-1.67) | .78 |
| HL/NHL | 0.99 (0.41-2.38) | .99 | 0.61 (0.31-1.19) | .14 | 0.68 (0.39-1.17) | .16 | 0.82 (0.42-1.60) | .56 |
| SAA/MM/others | 0.95 (0.33-2.69) | .92 | 0.59 (0.26-1.35) | .21 | 0.65 (0.33-1.29) | .22 | 0.65 (0.28-1.52) | .32 |
| Stem cell donor | ||||||||
| Autologous HCT | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Allogeneic, sibling donor | 1.35 (0.67-2.71) | .40 | 1.41 (0.85-2.33) | .19 | 1.28 (0.82-2.01) | .28 | 1.41 (0.81-2.46) | .22 |
| Allogeneic, unrelated donor | 1.61 (0.61-4.26) | .34 | 0.82 (0.36-1.87) | .64 | 1.60 (0.86-2.96) | .14 | 1.42 (0.65-3.08) | .38 |
| Transplant regimens | ||||||||
| Chemotherapy alone | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Total body irradiation–based | 1.63 (0.75-3.53) | .22 | 1.96 (1.06-3.63) | .03 | 1.63 (0.98-2.71) | .06 | 1.98 (1.03-3.80) | .04 |
| cGVHD (among allogeneic HCT survivors only) | ||||||||
| No | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Active cGVHD | 1.69 (0.66-4.33) | .27 | 1.47 (0.69-3.14) | .32 | 2.00 (1.03-3.89) | .04 | 2.20 (1.01-4.79) | .05 |
| Resolved cGVHD | 0.44 (0.15-1.33) | .15 | 1.49 (0.76-2.93) | .25 | 0.99 (0.51-1.93) | .98 | 1.13 (0.53-2.41) | .75 |
| Any immunosuppression (among allogeneic HCT survivors only) | ||||||||
| Methotrexate | 1.50 (0.54-4.19) | .44 | 0.66 (0.33-1.31) | .23 | 1.31 (0.66-2.58) | .44 | 0.79 (0.38-1.64) | .53 |
| Cyclosporine | 0.97 (0.32-2.91) | .95 | 2.93 (1.15-7.49) | .02 | 1.00 (0.46-2.20) | 1.00 | 1.31 (0.53-3.27) | .56 |
| Prednisone | 2.62 (1.11-6.19) | .03 | 2.27 (1.24-4.18) | .01 | 1.80 (1.04-3.11) | .04 | 2.28 (1.19-4.36) | .01 |
| . | Anxiety . | Depression . | Somatization . | Global distress . | ||||
|---|---|---|---|---|---|---|---|---|
| OR (95% CI) . | P . | OR (95% CI) . | P . | OR (95% CI) . | P . | OR (95% CI) . | P . | |
| Sex | ||||||||
| Female | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Male | 1.02 (0.56-1.86) | .95 | 1.80 (1.14-2.85) | .01 | 0.89 (0.60-1.31) | .55 | 1.09 (0.68-1.76) | .71 |
| Race/ethnicity | ||||||||
| Non-Hispanic white | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Others | 1.94 (0.98-3.87) | .06 | 1.28 (0.75-2.18) | .36 | 1.60 (0.99-2.60) | .05 | 2.04 (1.17-3.55) | .01 |
| Education | ||||||||
| Did not complete HS/HS graduate | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Some college or above | 0.62 (0.31-1.21) | .16 | 0.64 (0.38-1.09) | .10 | 1.26 (0.75-2.11) | .38 | 0.81 (0.46-1.43) | .47 |
| Household income, $ | ||||||||
| > 60 000/y | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| 20 000-60 000/y | 3.28 (1.41-7.59) | .01 | 2.12 (1.21-3.71) | .01 | 1.92 (1.21-3.05) | .01 | 2.04 (1.11-3.74) | .02 |
| < 20 000/y | 3.22 (1.08-9.64) | .04 | 3.10 (1.56-6.19) | < .001 | 2.28 (1.23-4.24) | .01 | 2.54 (1.21-5.35) | .01 |
| Health insurance | ||||||||
| Yes | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| No | 0.87 (0.31-2.43) | .80 | 1.16 (0.59-2.32) | .66 | 1.20 (0.61-2.37) | .60 | 1.35 (0.66-2.78) | .42 |
| Marital status | ||||||||
| Married | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| No | 0.82 (0.42-1.59) | .55 | 1.45 (0.88-2.37) | .14 | 1.02 (0.65-1.57) | .95 | 1.28 (0.76-2.17) | .35 |
| Health status | ||||||||
| Excellent/good | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Fair/poor | 3.80 (2.03-7.12) | < .0001 | 3.56 (2.20-5.74) | < .0001 | 5.58 (3.71-8.39) | < .0001 | 5.98 (3.65-9.81) | < .0001 |
| Chronic health condition | ||||||||
| None | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Grade1/2 | 1.36 (0.68-2.73) | .39 | 1.48 (0.88-2.48) | .14 | 1.44 (0.91-2.28) | .12 | 1.21 (0.70-2.10) | .49 |
| Grade3/4 | 1.39 (0.57-3.38) | .47 | 1.49 (0.76-2.90) | .24 | 1.91 (1.09-3.36) | .02 | 1.37 (0.68-2.74) | .38 |
| Risk of relapse at HCT | ||||||||
| Standard risk | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| High risk | 1.18 (0.64-2.20) | .59 | 0.75 (0.46-1.21) | .23 | 0.95 (0.63-1.43) | .81 | 0.77 (0.46-1.28) | .31 |
| Age at HCT, year (per 10 y) | 0.91 (0.70-1.20) | .52 | 0.80 (0.66-0.98) | .03 | 0.98 (0.82-1.17) | .86 | 0.88 (0.71-1.09) | .25 |
| Time since HCT (per 10 y) | 0.62 (0.29-1.29) | .20 | 0.55 (0.32-0.93) | .03 | 0.56 (0.35-0.92) | .02 | 0.56 (0.31-0.99) | .05 |
| Primary cancer diagnosis | ||||||||
| CML | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| AML/ALL | 1.32 (0.60-2.92) | .49 | 1.19 (0.69-2.08) | .53 | 0.94 (0.57-1.54) | .79 | 0.92 (0.50-1.67) | .78 |
| HL/NHL | 0.99 (0.41-2.38) | .99 | 0.61 (0.31-1.19) | .14 | 0.68 (0.39-1.17) | .16 | 0.82 (0.42-1.60) | .56 |
| SAA/MM/others | 0.95 (0.33-2.69) | .92 | 0.59 (0.26-1.35) | .21 | 0.65 (0.33-1.29) | .22 | 0.65 (0.28-1.52) | .32 |
| Stem cell donor | ||||||||
| Autologous HCT | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Allogeneic, sibling donor | 1.35 (0.67-2.71) | .40 | 1.41 (0.85-2.33) | .19 | 1.28 (0.82-2.01) | .28 | 1.41 (0.81-2.46) | .22 |
| Allogeneic, unrelated donor | 1.61 (0.61-4.26) | .34 | 0.82 (0.36-1.87) | .64 | 1.60 (0.86-2.96) | .14 | 1.42 (0.65-3.08) | .38 |
| Transplant regimens | ||||||||
| Chemotherapy alone | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Total body irradiation–based | 1.63 (0.75-3.53) | .22 | 1.96 (1.06-3.63) | .03 | 1.63 (0.98-2.71) | .06 | 1.98 (1.03-3.80) | .04 |
| cGVHD (among allogeneic HCT survivors only) | ||||||||
| No | 1.00 | 1.00 | 1.00 | 1.00 | ||||
| Active cGVHD | 1.69 (0.66-4.33) | .27 | 1.47 (0.69-3.14) | .32 | 2.00 (1.03-3.89) | .04 | 2.20 (1.01-4.79) | .05 |
| Resolved cGVHD | 0.44 (0.15-1.33) | .15 | 1.49 (0.76-2.93) | .25 | 0.99 (0.51-1.93) | .98 | 1.13 (0.53-2.41) | .75 |
| Any immunosuppression (among allogeneic HCT survivors only) | ||||||||
| Methotrexate | 1.50 (0.54-4.19) | .44 | 0.66 (0.33-1.31) | .23 | 1.31 (0.66-2.58) | .44 | 0.79 (0.38-1.64) | .53 |
| Cyclosporine | 0.97 (0.32-2.91) | .95 | 2.93 (1.15-7.49) | .02 | 1.00 (0.46-2.20) | 1.00 | 1.31 (0.53-3.27) | .56 |
| Prednisone | 2.62 (1.11-6.19) | .03 | 2.27 (1.24-4.18) | .01 | 1.80 (1.04-3.11) | .04 | 2.28 (1.19-4.36) | .01 |
Primary diagnosis, stem cell donor, transplant regimens, chronic GVHD, and use of immunosuppressants were included in the model one at a time. Adjusted for sex, age at study participation (continuous), race/ethnicity (non-Hispanic white, others), marital status (married, not married), income (< $20 000/y, 20 000-60 000/y, > 60 000/y), education (did not complete high school/high-school graduate, some college or above), insurance status (yes, no) and health status (poor/fair, good/excellent), grade of chronic health conditions (none, grade 1 or 2, grade 3 or 4).
HCT indicates hematopoietic cell transplantation; OR, odds ratio; CI, confidence interval; HS, high school; CML, chronic myeloid leukemia; AML, acute myeloid leukemia; ALL, acute lymphoid leukemia; HL, Hodgkin lymphoma; NHL, non-Hodgkin lymphoma; SAA, severe aplastic anemia; MM, multiple myeloma; and cGVHD, chronic GVHD.