The Burden in Caregivers of Multiple Myeloma Patients Undergoing Outpatient Autologous Stem-Cell Transplantation Compared to Inpatient Transplantation.

BACKGROUND: The application of different models of autologous stem-cell transplantation (ASCT) in multiple myeloma has demonstrated the feasibility and safety of outpatient-based programs of care. Although several systematic reviews have evaluated the burden of caregivers, only a few studies have included outpatient ASCT. PATIENTS AND METHODS: The feelings of lack of family support, daily activities, and general health were compared between caregivers of 2 groups of patients with multiple myeloma who underwent inpatient (n = 71) or outpatient (n = 25) ASCT. RESULTS: The 3 features did not significantly differ between the 2 study groups at baseline, before, and 3 months after ASCT. Multivariate modeling showed that the baseline values were significantly related to the changes in study outcomes independent of patient and caregiver characteristics. Other correlates were caregivers' work and patient age for impact on daily activities and disease burden across time for impact on general health (all P < .05). CONCLUSION: The outpatient model neither improves nor impairs global caregivers' burden compared to standard ASCT care. Further research is needed to confirm this observation and to better assess the burden and quality of life of caregivers and their influence on patient outcomes and quality of life.

Factors influencing the perception of protective isolation in patients undergoing haematopoietic stem cell transplantation: A multicentre prospective study.

OBJECTIVES: To identify which factors can influence the patients' perception of protective isolation following Haematopoietic Stem Cell Transplantation (HSCT). METHODS: This is a prospective study conducted in 10 Italian centres, members of the Italian Group of stem cell transplant (GITMO). Patients' perception of protective isolation was assessed using the ISOLA scale between 7 and 9 days post-transplant. Statistical linear regression analysis was performed. RESULTS: The participants were 182 adult patients receiving autologous (48%) or allogeneic (52%) HSCT in protective isolation. Male sex (ß = .152), education level (ß = -.245), double room (ß = .186), satisfaction with visiting hours (ß = -.174) and emotional support from nurses (ß = -.169) were independently associated with isolation-related suffering. Significant predictors of the relationship with oneself included body temperature (ß = -.179), fatigue (ß = -.192) and emotional support from nurses (ß = -.292). Factors independently associated with the relationship with others were education (ß = -.230), chemotherapy cycles (ß = -.218), pain (ß = .150) and satisfaction with visiting hours (ß = -.162). CONCLUSION: Healthcare providers should pay greater attention in caring for those patients who are at risk for a negative isolation experience. Nurses should provide emotional support.

Identification of the Optimal Recipient Layer for Transplanted Fat: A Prospective Study on Breast Lipoaugmentation.

BACKGROUND: Fat grafting has become a popular procedure in aesthetic and reconstructive surgeries due to its safety, minimal invasiveness, and favorable visual outcomes, although the volume retention rate is unpredictable. OBJECTIVES: A prospective clinical study on lipoaugmentation of the breast was conducted to compare fat retention rates in the pectoralis muscle and the periglandular area. METHODS: This prospective study included 20 breasts from 11 patients who underwent primary lipoaugmentation. Volume retention rate and percentage augmentation among different recipient layers, as well as complications and patient satisfaction, were evaluated. Magnetic resonance imaging was performed preoperatively and at 1 day and 3 months postoperatively. Complications were recorded, and patient satisfaction was appraised through the use of the Breast-Q questionnaire. RESULTS: Breasts were injected with 207 ± 29 mL of fat, achieving overall volume retention rates of 56.63% ± 16.40%. The overall augmentation was 21.53% ± 10.27%. Volume retention rate was significantly higher (59.00% ± 13.84%) in the periglandular area than in the pectoralis muscle (47.21% ± 22.41%) (P = 0.04). Augmentation was significantly higher (32.13% ± 12.96%) in the periglandular area than in the pectoralis muscle (4.95% ± 4.23%) (P = 0.00). Pain and numbness were the only reported complications. The Breast-Q score increased significantly for the measures "satisfaction with breasts," "psychosocial well-being," and "sexual well-being." CONCLUSIONS: Fat transfer is a safe and acceptable method for aesthetic and reconstructive breast surgery. The periglandular area was a better recipient site than muscle for transferred fat.

Calidad de vida de los pacientes sometidos al trasplante de células madre autólogo y alogénico en la hospitalización / Qualidade de vida dos pacientes submetidos ao transplante de células-tronco autólogo e alogênico na hospitalização / Quality of life of patients submitted to autologous and allogeneic stem cell transplant in hospitalization

Objetivo: Evaluar la calidad de vida de los pacientes adultos con cáncer hematológico de acuerdo con la modalidad de trasplante de células madre hematopoyéticas durante las etapas de hospitalización. Método: Estudio cuantitativo, observacional, longitudinal y analítico con 55 participantes adultos diagnosticados con cáncer hematológico sometidos al trasplante de células madre hematopoyéticas desde septiembre de 2013 hasta noviembre de 2015. Se utilizaron tres instrumentos, uno para caracterización sociodemográfica y clínica y dos instrumentos para evaluar la calidad de vida: el Quality Of Life Questionnaire - Core 30 (QLQ-C30), versión 3.0 portugués, desarrollado por la European Organization Research Treatment of Cancer (EORTC) y el cuestionario FunctionalAssessmentCancerTherapy- Bone Marrow Transplantation (FACT-BMT), versión 4.0 portugués, desarrollado por la Functional Assessment of ChronicIllness Therapy (FACIT), ambos validados para Brasil. Resultado: Los resultados demostraron que el promedio de edad para el trasplante de células madre hematopoyéticas autólogo fue de 45 años, el predominio del diagnóstico mieloma múltiple y para el trasplante de células madre alogénico fue de 31 años y como diagnóstico predominante la leucemia. La evaluación de la calidad de vida con ambos cuestionarios y modalidades demostró descenso significativo de los valores en todos los dominios evaluados, con predominio de peores puntuaciones en el período de pancitopenia, excepto para la función emocional. Conclusión: La presente investigación concluye que el trasplante de células madre hematopoyéticas altera la calidad de vida durante la hospitalización para ambas modalidades de trasplante. Los enfermeros deben promover intervenciones para mejorar la calidad de vida de los pacientes, abarcando dominios físicos, emocionales, sociales y funcionales

Objetivo: Avaliar a qualidade de vida dos pacientes adultos com câncer hematológico de acordo com a modalidade de transplante de células-tronco hematopoética durante as etapas de hospitalização. Método: Estudo quantitativo, observacional, longitudinal e analítico, com 55 participantes adultos, diagnosticados com câncer hematológico que se submeteram ao transplante de células-tronco hematopoéticas de setembro de 2013 a novembro de 2015. Foram utilizados três instrumentos, um para caracterização sociodemográfica e clínica e dois instrumentos para avaliação da qualidade de vida: o QualityOf Life Questionnaire-Core 30(QLQ-C30), versão 3.0 português, desenvolvido pela European Organization Research Treatment of Cancer (EORTC) e o questionário Functional Assessment Cancer Therapy-Bone Marrow Transplantation (FACT-BMT), versão 4.0 português, desenvolvido pela Functional Assessment of ChronicIllnessTherapy(FACIT), ambos validados para o Brasil. Resultado: Os resultados demonstraram que a média de idade para o transplante de células-tronco hematopoéticas autólogo foi 45 anos e predomínio do diagnóstico mieloma múltiplo e para o transplante de células-tronco alogênico foi 31 anos e como diagnostico predominante a leucemia. A avaliação da qualidade de vida com ambos os questionários e modalidades demonstrou que há queda significante dos valores em todos os domínios avaliados, com predomínio de piores pontuações no período de pancitopenia, exceto para a função emocional. Conclusão: A presente pesquisa conclui que o transplante de células-tronco hematopoéticas altera a qualidade de vida durante a hospitalização para ambas as modalidades de transplante. Cabe à enfermeira promover intervenções para melhorar a Qualidade de Vida dos pacientes, abrangendo domínios físicos, emocionais, sociais e funcionais

Objective: To evaluate the quality of life of adult patients with hematologic cancer according to the modality of hematopoietic stem cell transplant during hospitalization stages. Method: A quantitative, observational, longitudinal and analytical study with 55 adult participants diagnosed with hematologic cancer who underwent hematopoietic stem cell transplant between September 2013 and November 2015. Three instruments were used, one for sociodemographic and clinical characterization, and two instruments for quality of life assessment, as follows: the Quality Of Life Questionnaire-Core30 (QLQ-C30), version 3.0 in Portuguese developed by the European Organization Research Treatment of Cancer (EORTC) and the Functional Assessment Cancer Therapy-Bone Marrow Transplantation (FACT-BMT) questionnaire, version 4.0 in Portuguese developed by the Functional Assessment of Chronic Illness Therapy (FACIT), both validated for Brazil. Result: The results showed the mean age for autologous hematopoietic stem cell transplant was 45 years, the prevalence of multiple myeloma diagnosis and for allogeneic stem cell transplant was 31 years, and leukemia was the predominant diagnosis. The quality of life assessment with both questionnaires and modalities showed a significant decrease in values in all domains evaluated, with predominance of worse scores in the pancytopenia period, except for the emotional function. Conclusion: The present study concludes that hematopoietic stem cell transplant changes the quality of life during hospitalization for both transplant modalities. The promotion of interventions to improve patients' quality of life by covering physical, emotional, social and functional domains is the nurses' role

Sociodemographic and psychological determinants of influenza vaccine intention among recipients of autologous and allogeneic haematopoietic stem cell transplant: a cross-sectional survey of UK transplant recipients using a modified health belief model.

OBJECTIVES: Studies exploring vaccination rates among haematopoietic stem cell transplant (HSCT) recipients have focused on physician factors that limit uptake. Understanding the patient factors that determine vaccination intention is crucial to delivering a successful vaccination programme. Using a modified health belief model (mHBM), we conducted a cross-sectional survey with the objective of exploring the sociodemographic and psychological factors that determined autologous and allogeneic HSCT recipients' intention to receive the seasonal inactivated influenza vaccine (SIIV) during the 2015-2016 influenza season. SETTING: The setting of our study was three tertiary level, UK National Health Service (NHS) autologous and allogeneic HSCT centres. PARTICIPANTS: Eligible patients were aged 16 years or over and recipients of autologous or allogeneic HSCT for any disease indication, with no absolute contraindication to receiving the SIIV during the next influenza season, and having not received the SIIV since transplant. 93 participants from 3 UK NHS HSCT centres completed an anonymous study-specific questionnaire. 78.5% were recipients of allogeneic and 21.5% autologous HSCT. RESULTS: 23.7% of participants expressed low intent to receive the SIIV. Patients aged over 65 (OR 0.02, 95% CI 0.01 to 0.57, p=0.02) and those who had not received the SIIV prior to HSCT (OR 0.04, 95% CI 0.02 to 0.56, p=0.02) were less likely to have high intent. A multivariate logistic regression model incorporating constructs of the mHBM was statistically significant (p<0.001) and explained 74.7% of variation in SIIV intention. More patients felt that a recommendation from their HSCT team than their general practitioner would prompt them to receive the SIIV, and this was most pronounced in those who had low intent. CONCLUSIONS: The mHBM may provide a useful structure for addressing low vaccine intent among HSCT recipients and further interventional studies are warranted. We would encourage HSCT and general practitioners to discuss SIIV intention as a routine part of care.

The lived experience of autologous stem cell-transplanted patients: Post-transplantation and before discharge.

AIMS AND OBJECTIVES: To explore the lived experience of the patients post-haematopoietic stem cell transplantation and specifically after engraftment and before discharge. BACKGROUND: Patients post-stem cell transplantation experience significant changes in all life aspects. Previous studies carried out by other researchers focused mainly on the postdischarge experience, where patients reported their perceptions that have always been affected by the life post-transplantation and influenced by their surroundings. The lived experience of patients, specifically after engraftment and prior to discharge (the "transition" phase), has not been adequately explored in the literature. Doing so might provide greater insight into the cause of change post-haematopoietic stem cell transplantation. DESIGN: This study is a phenomenological description of the participants' perception about their lived experience post-haematopoietic stem cell transplantation. The study used Giorgi's method of analysis. METHODS: Through purposive sampling, 15 post-haematopoietic stem cell transplantation patients were recruited. Data were collected by individual interviews. Data were then analysed based on Giorgi's method of analysis to reveal the meaning of a phenomenon as experienced through the identification of essential themes. RESULTS: The analysis process revealed 12 core themes covered by four categories that detailed patients lived experience post-haematopoietic stem cell transplantation. The four categories were general transplant experience, effects of transplantation, factors of stress alleviation and finally life post-transplantation. CONCLUSION: This study showed how the haematopoietic stem cell transplantation affected the patients' physical, psychological and spiritual well-being. Transplantation also impacted on the patients' way of thinking and perception of life. Attending to patients' needs during transplantation might help to alleviate the severity of the effects and therefore improve experience. RELEVANCE TO CLINICAL PRACTICE: Comprehensive information about transplantation needs to be provided over different intervals and at different occasions. The role of the haematopoietic stem cell transplantation coordinators is important, and their communication skills and knowledge were found to be significant in patients' preparation and decision-making. As healthcare providers usually attend to only the patients' physical and psychological needs, spirituality was found to play an important role in maintaining morale and making sense of the meaning of life.

Patient reported outcomes of autologous fat grafting after breast cancer surgery.

INTRODUCTION: Autologous fat grafting (AFG) can be used as an adjunct in breast cancer surgery to improve contour defects. Few previous studies have assessed patient reported outcomes (PROs) for AFG. This study analysed AFG use and assessed PROs in terms of physical and psychosocial well-being. MATERIALS AND METHODS: All patients undergoing AFG were identified from a prospective database and asked to complete the validated BREAST-Q questionnaire and a tool to assess patient-perceived change after AFG (5-point Likert-type scale). Descriptive statistics were computed for all BREAST-Q and perceived change subscales. Independent sample t-tests were conducted to compare scores on each of the BREAST-Q and perceived change subscales by type of breast cancer surgery and radiotherapy status. RESULTS: 156 AFG sessions were performed over 4 years on 119 breasts in 88 patients. Fifty-seven patients received AFG after reconstruction and 19 after breast conserving surgery. Forty-six patients (52%) completed the questionnaire. BREAST-Q scores (out of 100) and patient-perceived change after AFG (out of 5) were respectively: 54 and 4.0 for Breast satisfaction, 69 and 3.3 for Physical well-being and 60 and 3.6 for Psychosocial well-being. Radiotherapy status and type of surgery made little difference. Number of AFG procedures positively correlated with perceived improvement. DISCUSSION: Autologous fat grafting was associated with improved patient satisfaction despite small volumes transferred. BREAST-Q scores were comparable with previously published series on reconstructive breast surgery. Perceived change after AFG was no different in patients receiving radiotherapy.

Long-term outcomes of autologous hematopoietic stem cell transplantation with reduced-intensity conditioning in multiple sclerosis: physician's and patient's perspectives.

High-dose immunosuppressive therapy (HDIT) with autologous hematopoietic stem cell transplantation (AHSCT) is a promising approach to treatment of multiple sclerosis (MS) patients. In this paper, we present the long-term outcomes of a prospective single-center study with the analysis of the safety and efficacy of HDIT + AHSCT with reduced-intensity BEAM-like conditioning regimen in 99 MS patients: mean age-35 years old; male/female-39/60; median Expanded Disability Status Scale (EDSS) = 3.5; 43 relapsing/remitting MS, 56 progressive MS. No transplant-related deaths were observed. The mobilization and transplantation procedures were well tolerated. At 6 months post-transplant, neurological improvement or stabilization was observed in all the patients except one. Cumulative incidence of disease progression was 16.7 % at 8 years after HDIT + AHSCT. Estimated event-free survival at median follow-up of 48.9 months was 80 %: 83.3 % in relapsing/remitting MS vs 75.5 % in progressive MS. Sixty-four patients who did not progress during the first 3 years post-transplant and were monitored for more than 3 years were included in long-term outcome analysis. At the median long-term follow-up of 62 months, 47 % of patients improved by at least 0.5 points on the EDSS scale as compared to baseline and exhibited improvement during the entire period of follow-up; 45 % of patients were stable. No active, new, or enlarging lesions on magnetic resonance imaging were registered in patients without disease progression. AHSCT was accompanied by a significant improvement in patient's quality of life. Due to the fact that patient selection was quite different to the other studies and that the information about disease activity prior in the disease course and its treatment was inhomogeneous, comparison with the results in the literature should be done with caution. Thus, the risk/benefit ratio of HDIT + AHSCT with reduced-intensity BEAM-like conditioning regimen in our population of MS patients is very favorable. The consistency of our long-term clinical and quality of life results, together with the persistence of improvement, is in favor of the efficacy and safety of this treatment approach in MS patients.

A question of ethics: selling autologous stem cell therapies flaunts professional standards.

The idea that the body's own stem cells could act as a repair kit for many conditions, including cardiac repair, underpins regenerative medicine. While progress is being made, with hundreds of clinical trials underway to evaluate possible autologous cell-based therapies, some patients and physicians are not prepared to wait and are pursuing treatments without evidence that the proposed treatments are effective, or even safe. This article explores the inherent tension between patients, practitioners and the need to regulate the development and commercialization of new cellular therapies--even when the cells come from the patient.

Parental perceptions of posterior pharyngeal wall augmentation using autologous fat for treating velopharyngeal dysfunction.

Posterior pharyngeal wall augmentation using autologous fat to treat velopharyngeal dysfunction (VPD) is an alternative surgical procedure to more commonly used invasive procedures such as the pharyngeal flap. However, limited research exists on this technique. The aim of this study was to qualitatively investigate parental perceptions of posterior pharyngeal wall augmentation using autologous fat when treating velopharyngeal dysfunction. Furthermore, this research aimed to examine parent's perspectives of their child's speech and quality-of-life following this procedure. A qualitative collective case study methodology was used in the form of semi-structured interviews with seven participants. These were then analysed using constant comparative analysis. Four distinct themes emerged: post-surgical outcomes; speech-language pathology, not just medicine; factors for successful post-operative speech and resonance; and long-term sustainability and worthiness of the procedure. Six out of seven participants expressed positive post-operative speech and resonance results. Five further expressed long-term satisfaction up to 6 years post-operatively. Overall the majority of participants were satisfied that this procedure provided their child with long-term successful speech outcomes. The participants also discussed the importance of receiving speech-language pathology services alongside surgery and the positive impact of the procedure on their child's quality-of-life including social interactions, confidence, friendships, as well as eating and drinking.

Analysis of attitudes toward the source of progenitor cells in tissue-engineered products for use in burns compared with other disease states.

The first trials using progenitor cells to improve burn wound healing are beginning. However, there remains a paucity of data on patients' opinions of the source of stem cells. In this study, 279 patients attending plastic surgery/burns outpatient and medical outpatient clinics were questioned to assess willingness to accept a tissue-engineered skin product derived from a variety of sources. Levels of acceptance for the use of progenitor cells derived from these sources for treatment across a range of disease states (burns, Parkinson's disease, diabetes, and for cosmetic use) were also assessed. Overall, 80% of those questioned would accept a tissue-engineered product. Autologous cells were the preferred choice of cells (acute burns 94%, diabetes 95%, Parkinson's 93.9%). Allogeneic cells were still widely accepted (acute burns 67%, diabetes 66.7%, Parkinson's 69.2%). There was no difference observed between plastic surgical patients and medical patients in acceptance of cell therapy for burns, Parkinson's disease, or diabetes. There is good potential acceptance for the use of both autologous and allogeneic cells for the treatment of acute burns and burns' scarring as well as in diabetes and Parkinson's disease. Disease state does not appear to influence overall acceptability and choice of cells.

Toe-to-hand transplantation surgery.

This article discusses toe-to-hand transplantation. The purpose of this article is to familiarize nurses with this procedure. In many cases, the actions taken initially and postoperatively may have a direct effect on the success or failure of the surgery. Two different procedures are discussed. The first procedure is replantation or revascularization of amputated digits in which time is of the essence and is usually performed right after the initial injury. The second procedure is the toe-to-hand transfer, which is an elective procedure in which there is less emphasis on time. This procedure occurs a few months after the initial accident.

Maternal perspectives on children's health-related quality of life during the first year after pediatric hematopoietic stem cell transplant.

OBJECTIVE: To assess the longitudinal health-related quality of life (HRQL) of children receiving hematopoietic stem cell transplantation (HSCT). METHODS: Mothers (N = 160) of HSCT recipients aged 5-20 at six US transplant centers completed the Child Health Ratings Inventories (CHRIs), the Disease Impairment Inventory (DSII)-HSCT module, and the Short Form (SF)-36 at baseline, 3, 6, and 12 months. RESULTS: HRQL domain scores at baseline varied by recipient age and program site. Longitudinal data over the first year post-HSCT revealed lowest functioning at baseline and 3 months, with largest improvement in functioning between the 3 and 6-months assessments and continued improvement from 6 to 12 months. Recipients of unrelated donor transplants had steepest declines in functioning at 3 months and great HSCT-specific issues at 3 and 6 months. Among children who survived the first year, functioning at 12 months was similar across transplant types and surpassed baseline scores. Children who did not survive the first year exhibited deterioration in HRQL in the months before death and trajectories were strikingly different than for survivors. CONCLUSIONS: This study offers the first glimpse of the 12-month trajectory of HRQL following pediatric HSCT from mothers' perspectives. This study also highlights the importance of and approaches to addressing missing data in longitudinal research.

Characteristics and correlates of cognitive functioning following bone marrow transplantation.

Patients who undergo bone marrow transplantation (BMT) often report cognitive problems following treatment. This study used cognitive tests and a self-report measure of subjective cognitive complaints to determine (1) the rate of objective cognitive impairment in a sample of 65 BMT patients, and (2) the correspondence of patients' cognitive complaints to their actual cognitive performance. At 6 months following BMT, patients were assessed in seven cognitive domains--attention, verbal learning, verbal memory, visual memory, simple executive function, complex executive function, and psychomotor speed. Cognitive complaints were likewise assessed. In all, 51% had at least mild impairment (-1 standard deviation (s.d.) below published norms) in one or more cognitive domains, with 28% demonstrating moderate-to-severe impairment (-2 s.d.). Older patients and patients with lower IQ were more likely to score in the impaired range on objective cognitive tests, with males and the less educated showing trends toward scores in the impaired range. Younger patients made significantly more cognitive complaints. Total cognitive complaints were unrelated to average cognitive performance, and complaints in specific cognitive domains were largely unrelated to objective performance on corresponding domains. Findings suggest that patients who complain about their cognitive performance following BMT differ from those who experience actual deficits.

Fatigue and depression in patients with lymphoma undergoing autologous peripheral blood stem cell transplantation.

PURPOSE/OBJECTIVES: To describe the patterns of depression and fatigue, including its dimensions, and the relationship between these two variables in patients with lymphoma undergoing autologous peripheral blood stem cell transplantation (PBSCT). DESIGN: Prospective, descriptive, correlational, repeated measures. SETTING: Midwestern university National Cancer Institute-designated clinical cancer center. SAMPLE: 27 patients with lymphoma aged 19 to 71 undergoing autologous PBSCT. METHODS: The revised Piper Fatigue Scale was used to measure fatigue and its dimensions. The Center for Epidemiologic Studies' Depression Scale was used to measure depression on selected days at baseline and during chemotherapy and recovery. MAIN RESEARCH VARIABLES: Fatigue and its four dimensions (behavioral/severity, sensory, cognitive/mood, and affective meaning) and depression. FINDINGS: Total fatigue, fatigues four dimension scores, and depression scores changed significantly over time, with the highest scores at day + 7 after transplant. Total fatigue and the four dimension scores were highly and positively correlated with depression, with the highest correlation reported between the affective fatigue dimension and depression. CONCLUSIONS: The findings support the importance of assessing fatigue and depression in patients undergoing autologous PBSCT at baseline, during chemotherapy, and throughout recovery. IMPLICATIONS FOR NURSING: Routine clinical assessment with close observation around day +7 after transplant and patient education about the patterns of fatigue and depression will help the healthcare team to intervene at the appropriate time and may help patients to better manage these symptoms.

Psychosocial adjustment and quality of life among multiple myeloma patients undergoing evaluation for autologous stem cell transplantation.

Stem cell transplantation has assumed a prominent place in the treatment of multiple myeloma, but relative to patients with other malignancies there is surprisingly little information about the adjustment difficulties and quality-of-life changes that these patients experience. This study examined psychosocial and functional deficits among myeloma patients assessed at a uniform period during their initial diagnostic evaluation, prior to beginning protocols at a transplant center. Validated self-report measures and clinician rating scales were used to assess 213 patients. Outcomes evaluated included emotional distress (Hospital Anxiety and Depression Scale, Brief Symptom Inventory), depression (Hamilton Depression Rating Scale), physical functioning, pain, and energy (SF-12). A significant proportion of patients experienced compromised psychosocial and physical functioning. Roughly one-third reported clinically elevated levels of distress, anxiety, and depression. In all, 59% scored below age-adjusted norms for daily physical functioning, 58% reported at least moderate levels of pain, and over 80% noted at least moderate fatigue. Clinical and demographic correlates of these outcomes were examined. These findings are among the first to characterize quality-of-life outcomes among myeloma patients in the transplant setting, and indicate that many patients experience considerable supportive care needs even prior to beginning aggressive regimens. Results highlight the importance of early screening.

How do parents perceive high-dose chemotherapy and autologous stem cell transplantation for their children.

Our objective was to understand the parents' perception of children treated in an ASCT unit. Parents (40) of children and adolescents were interviewed by the department psychiatrist-psychoanalyst, over 9 months. They expressed great distress (22), considerable difficulty in assuming their parental role (with feelings of helplessness and guilt), and had distorted relations with the child whose behavior was unusual and incomprehensible (22). The relation with care providers, who should be 'all-powerful' and harmless, was ambivalent (15). They found it difficult to think or refused to do so, because their 'thoughts are terrifying', and they wanted to forget everything (11). The couple was going through a crisis (9). Temporal landmarks were disturbed (8); ASCT was experienced as a threatening discontinuity in the course of treatment (parents were unable to think of the past, the future, or the present); social landmarks were disturbed (6) with loss of social and professional relations. We concluded that parents may experience intense distress and disorientation. Trained to understand the parents' and their children's thoughts and behavior, the medical team, which includes a psycho-oncologist, can better help them to understand and support the children, to strike a balance between their parental role and other responsibilities, and prevent conflicts.