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Late Effects of Cancer and Hematopoietic Stem-Cell Transplantation on Spouses or Partners Compared With Survivors and Survivor-Matched Controls

Michelle M. Bishop, Jennifer L. Beaumont, Elizabeth A. Hahn, David Cella, Michael A. Andrykowski, Marianne J. Brady, Mary M. Horowitz, Kathleen A. Sobocinski, J. Douglas Rizzo, John R. Wingard

From the Department of Medicine, University of Florida College of Medicine, Gainesville, FL; Center on Outcomes, Research and Education at Evanston Northwestern Healthcare, Evanston, IL; University of Kentucky College of Medicine, Lexington, KY; Independent Consultant, Trout Creek, MI; and Center for International Blood and Marrow Transplant Research, Health Policy Institute, Medical College of Wisconsin, Milwaukee, WI

Address reprint requests to Michelle M. Bishop, PhD, University of Florida, Department of Medicine, Box 100277, Gainesville, FL 32610-0277; e-mail: bishomm{at}medicine.ufl.edu

Purpose Little is known about the long-term effects of cancer and hematopoietic stem-cell transplantation (HCT) on spouses or partners. The purpose of this study was to examine the health-related quality of life and post-traumatic growth (PTG) of spouses/partners compared with survivors and controls and to identify factors associated with those outcomes.

Patients and Methods HCT survivor/partner pairs (n = 177), coupled continuously since HCT, were drawn from 40 North American transplantation centers. Married peer-nominated acquaintances (of survivors) served as controls (n = 133). Outcomes were measured a mean of 6.7 years after HCT (range, 1.9 to 19.4 years).

Results As expected, self-reported partner physical health was similar to controls and better than survivors (P < .001). However, partners reported more fatigue and cognitive dysfunction than controls (P < .001 for both), although less than survivors. Partners and survivors reported more depressive symptoms and sleep and sexual problems than controls (P < .001, P < .01, and P < .01, respectively). Odds of partner depression were nearly 3.5 times that of controls (P < .002). Depressed partners were less likely than depressed survivors to receive mental health treatment (P < .04). Partners reported less social support (P < .001), dyadic satisfaction (P < .05), and spiritual well-being (P < .05) and more loneliness (P < .05) than both survivors and controls. In contrast to survivors, partners reported little PTG (P < .001). Factors associated with partner outcomes included partner health problems, coping, female sex, social constraint, survivor depression, optimism, multiple life changes, and social support.

Conclusion Spouses/partners experience similar emotional and greater social long-term costs of cancer and HCT than survivors without the potential compensatory benefits of PTG. Some of the factors associated with partner outcomes are amenable to intervention.

Supported by Grants No. R01 CA81320 (J.R.W.) and K23 CA82350 (J.D.R.) from the National Institutes of Health.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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