DOI
https://doi.org/10.25772/5SEK-Y296
Defense Date
2014
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Nursing
First Advisor
Suzanne Ameringer
Second Advisor
Debra Lyon
Third Advisor
Ronald K. Elswick
Fourth Advisor
John McCarty
Abstract
Introduction: Chronic graft-versus-host disease (cGVHD) is a serious complication following allo-HSCT characterized by immune dysregulation, organ dysfunction, risk for infection, and distressing symptoms. Complications may include scleroderma, hepatic dysfunction and bronchiolitis obliterans. Advances in allo-HSCT for many hematologic dyscrasias (e.g. acute and chronic leukemias, aplastic anemia, and myelodysplastic syndrome) have improved survival which has generated a renewed focus on survivorship issues. Distressing symptoms are noted as negatively impacting quality of life (QoL). The relationship between inflammation and behavioral responses may impact symptoms. Examining patterns and levels of inflammation with symptoms is relevant. Objective: The aims of this study were to examine: 1) levels of symptoms (cGVHD specific, general symptoms, and cluster symptoms [pain, depression and fatigue]), inflammation (cytokines [Interleukin {IL}-1β, IL-6, IL-10, TNF, and INF-γ] and C-reactive protein [CRP]) and QoL in patients diagnosed with cGVHD and 2) relationships between and among symptoms, inflammation and QoL in individuals with cGVHD. Methods: A cross-sectional study design examined 24 individuals (ages 29-79) with cGVHD enrolled from an NCI-designated cancer center after obtaining informed consent. Data were collected using medical record and validated questionnaires. Plasma cytokine levels were measured using BioRad® multiplex assay. C-reactive protein levels were measures using an enzyme-linked immunosorbant assay. Statistical analyses included descriptive statistics and pairwise correlations. Results: A total of 24 participants (58.3% female) with cGVHD enrolled in this study. Multiple, concurrent symptoms were noted. Several pro-inflammatory cytokines were higher in participants with symptoms versus those without symptoms. IL-6 correlated with lack of energy (r= .42; p= .04) and dry mouth (r= .42; p= .04). IL-10 was correlated with difficulty sleeping (r= .43; p= .03). Sexual dysfunction correlated with social well-being (r= -.44; p=.03). Many symptoms negatively correlated with QoL. Conclusion: Findings from this study, one of the first to examine levels of symptoms and inflammatory markers in individuals with cGVHD, demonstrate significant relationships among symptoms, inflammation, and quality of life. The relationship of inflammatory biomarkers with symptoms emphasizes the need for further interdisciplinary research. Better understanding mechanisms associated with symptoms is necessary for the development and testing of targeted interventions to improve QoL for individuals with cGVHD.
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
5-11-2014