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Distress and Depression Among Bone and Marrow Transplant Patients by Kari Isaak, RN, BSN
ABSTRACT Bone and Marrow Transplant (BMT) is a five step treatment process: screening, collecting, conditioning, infusion, and engraftment. Bone and marrow transplant treatment is very aggressive that creates significant physical, social, psychological, and emotional stress. During the treatment process, many BMT recipients experience and display a wide array of psychosocial disorders including distress, anxiety, and depression. The way an individual experiences and copes with the distress, anxiety, and depression contributes to the physiological, psychological, and psychosocial outcomes of BMT treatment. The paper will discuss how distress and depression impact the physiological, psychological, and psychosocial outcomes with the BMT population, explain the Transactional Model of Stress and Coping theoretical framework, review literature findings evaluating the relationship between social support, coping, distress and depression, and discuss depression symptom interventions. Bone marrow is a soft, spongy tissue found inside bones where all blood cells are produced. Every type blood cell in marrow begins as a hematopoietic stem cell or “parent cell”. The stem cells form and differentiate into leukocytes, erythrocytes, and platelets. Leukocytes are further differentiated into neutrophils, eosinophils, basophils, monocytes, and lymphocytes. (National Bone Marrow Transplant Link (NBMTL), 2006).Various diseases and conditions can cause bone marrow malfunction to produce immature or defective blood cells. Diseases examples, but not limited to, include POEMS, acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), lymphoma, aplastic anemia, primary amyloidosis, multiple myeloma, myeloproliferative disorders, and solid tumors. Certain side effects of high doses of chemotherapy and radiation therapy may cause bone marrow malfunction. (Autologous Blood and Marrow Transplant, Mayo Foundation for Medical Education & Research (MFMER), 2008) Stem cells sources are found in the bone marrow, peripheral blood, and placenta. BMT is used as a treatment for the diseases and cancers causing bone marrow malfunction. Initially, the first source of stem cells was collected at the hip bone performed through a surgical procedure called a bone marrow biopsy. The discovery of hematopoietic stem cells in the peripheral blood has lead to the major source of stem cells rather than the bone marrow. The collection of peripheral blood stem cells is referred to as hematopoietic stem cell transplant (HSCT). The stem cell donor determines which type of transplant will be performed. An autologus transplant receives own stem cells. An allogeneic-related transplant receives stem cells from a genetically-matched family member. An allogeneic-unrelated transplant receives stem cells from an unrelated person. A syngeneic transplant receives stem cells from an identical twin. (NBMTL, 2006). Bone and marrow transplantation is completed through a five step process: screening, collecting, conditioning, infusion, and engraftment. The screening phase includes a comprehensive medical history, physical exam, psychosocial evaluation. Additional testing in the phase includes evaluating the function of vital organs (x-rays, CT, PET scan, bone marrow aspiration & biopsy). The collection phase is where donor receives stem cells are collected and harvested from patient or donor via bone marrow aspiration or peripheral blood stem cell aphaeresis. The conditioning phase refers to when chemotherapy and /or radiation therapy administered to patient to destroy cancer cells. The infusion phase includes administering the harvested stem cells which travel to bone marrow spaces making new blood cells. The infusion period usually last three weeks which during this time the transplant patient has a limited immune system. Engraftment phase occurs when the transplanted stem cells begin to produce normal blood cells that can be detected in the blood. (MFMER, 2008). Bone and marrow transplant treatment is very aggressive that creates significant physical, social, psychological, and emotional stress. The physical consequences from treatment can include fever, fatigue, nausea, vomiting, anemia, appetite changes, constipation, diarrhea, hair loss, infection, memory changes, mouth sores, and pain. Additionally, BMT treatment can exacerbate stressors including prolonged hospitalization, isolation, change in appearance, fear of transplant failure, and death. During the treatment process, many BMT recipients experience and display a wide array of psychological disorders including distress, anxiety, and depression. The way an individual experiences and copes with the distress, anxiety, and depression contributes to the physiological, psychological, and psychosocial outcomes of BMT treatment.
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