) This application proposes to evaluate factors requiring intervention to enhance long-term survival in adults after blood or marrow transplantation (BMT). In previous work, we have followed patients prospectively from pre-transplant with psychophysical, neuropsychologic, and endocrinologic assessments. With this application, we would continue outcome evaluation of two cohorts of survivors. We have followed the first cohort to five years and will complete a ten-year follow-up to evaluate late effects (n = 108 five year survivors plus a matched comparison sample). The second cohort of survivors participated in a randomized controlled clinical trial to enhance recovery from BMT. This cohort will complete follow-up to five years, with testing that includes neuropsychologic and endocrinologic evaluation (n = 100 five year survivors plus a matched comparison sample) to determine long-term survivor issues and efficacy of the clinical trial. A small subset of the second cohort would participate in a pilot study of interventions to reduce long-term impacts in at-risk survivors.
Specific aims are to: 1) evaluate the functional capabilities of adult BMT recipients in work, stamina, cognition, family adaptations, emotional fluctuations, infertility, and, for women, menopausal symptoms and sexual function; 2) evaluate the interaction of medical and psychophysical late effects in ten-year survivors as compared with their own status at five years and pre-transplant; 3) identify areas that have an impact on long-term survivors to a greater extent than matched healthy comparison samples; 4) define predictors of physiologic and psychologic morbidity in long-term survivors; 5) examine, prospectively, long-term neuropsychological and hormonal changes and their impacts; 6) evaluate the long-term outcome of a randomized controlled clinical trial to enhance recovery; and 7) design and pilot interventions to target at-risk long-term survivors as defined by this research. Hypotheses are defined in the application. This study is an interdisciplinary research effort which considers medical, psychological, social, functional, hormonal, and neuropsychological interactions in addressing the problems and needs of long-term survivors. The BMT setting provides a well standardized environment in which to examine these aims, all of which are applicable both to the ever-increasing numbers of transplantation survivors and to other populations of cancer survivors.
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