Increasing numbers of patients face the end-of-life following technologically advanced medical interventions. Cancer patients receiving autologous blood or marrow transplantations are a good example of this category of patients who face mortality after advanced clinical care. We know little of what happens to these patients at the end of their lives, such as their symptom patterns, emotional status, and when or whether a decision is made to transition to palliative care. The specific objectives of the proposed research are: (1) to assess the symptoms of metastatic breast cancer, high risk non-Hodgkin's lymphoma, and multiple myeloma patients who will die during the year following transplantation in order to identify changes in symptoms and symptom patterns that predict the end-of-life; (2) to determine the relationships among symptoms, functional status, quality of life, and length of survival post-transplant; and (3) to evaluate the efficacy of an IVR system in improving symptom assessment, symptom management, and quality of life for metastatic breast cancer, high risk non-Hodgkin's lymphoma, and multiple myeloma patients after transplantation, and a randomized clinical trial to evaluate the efficacy of an IVR system to monitor and triage the symptoms of patients during the post-transplantation period. The phase I descriptive study will enroll 110 patients with metastatic breast cancer, high risk non-Hodgkin's lymphoma, or multiple myeloma who are scheduled for autologous transplantations. The patients will complete pre-transplant measures of symptoms, quality of life, and functional status. Physical, affective, and cognitive symptoms will be monitored during the patients' hospitalization. Following discharge, the patients' symptoms will be assessed using the IVR system until death or the end of the first post-transplant year. In the phase II study, 154 patients with metastatic breast cancer, high risk non-Hodgkin's lymphoma, or multiple myeloma who are scheduled for transplants will be randomly assigned to the experimental (IVR assessment plus triage) or control (IVR assessment only) condition. The symptom data of patients in the experimental condition will be provided to their M.D. Anderson physicians and nurses during the first 30 days after discharge from the hospital. After patients return to their home communities, the IVR system will continue to assess the symptoms of patients in the experimental group and will provide the symptom information directly to the patients' local physicians. Outcome variables will include the patients' symptom intensities and frequencies, functional status, and quality of the end of life. It is predicted that patients in the experimental condition who die during the year will demonstrate better symptom management and quality of the end of life than patients in the control condition.
| Campagnaro, Erica; Saliba, Rima; Giralt, Sergio et al. (2008) Symptom burden after autologous stem cell transplantation for multiple myeloma. Cancer 112:1617-24 |
| Anderson, K O; Giralt, S A; Mendoza, T R et al. (2007) Symptom burden in patients undergoing autologous stem-cell transplantation. Bone Marrow Transplant 39:759-66 |
| Cleeland, Charles S (2006) The measurement of pain from metastatic bone disease: capturing the patient's experience. Clin Cancer Res 12:6236s-6242s |
| Anderson, Karen O; Mendoza, Tito R; Payne, Richard et al. (2004) Pain education for underserved minority cancer patients: a randomized controlled trial. J Clin Oncol 22:4918-25 |
| Anderson, Karen O; Getto, Carl J; Mendoza, Tito R et al. (2003) Fatigue and sleep disturbance in patients with cancer, patients with clinical depression, and community-dwelling adults. J Pain Symptom Manage 25:307-18 |
