LAUSR

Background Allogeneic stem cell transplant survivors with cGVHD experience significant psychological distress and substantial impairments in their QOL. However, the relationship between patients’ physical functioning, symptom burden, coping strategies, and QOL over time is currently unknown. Methods We conducted a longitudinal study of patients with moderate to severe cGVHD recruited from a single institution. We assessed patient-reported psychological distress (Hospital Anxiety and Depression Scale), QOL (Functional Assessment of Cancer Therapy- General), physical functioning (Human Activity Profile), cGVHD symptom burden (Lee Symptom Scale), and coping (Coping Inventory for Stressful Situations) at baseline, 3 months, and 6 months. Using mixed linear effects models, we longitudinally examined the relationship between patients’ QOL and their physical functioning, cGVHD symptoms, and coping strategies. Results We enrolled 53 patients with moderate (71.7%, 38/53) or severe (28.3%, 15/53) cGVHD. The rate of clinically significant depression and anxiety symptoms at baseline was 32.1% (17/53) and 30.2% (16/33), respectively. Depression and anxiety symptoms did not change substantially over time. Patients reported impaired QOL at baseline [FACT-G: mean=70.33, SD=18.96] which did not change significantly over time [β=-0.66, SE=1.11, P=0.550]. Higher physical functioning was associated with better QOL [β=0.17, SE=0.05, P=0.001] over time, while higher symptom burden was associated with worse QOL [β=-0.38, SE=0.06, P Conclusion Patients with moderate or severe cGVHD report substantial psychological distress and persistently impaired QOL over time. Higher physical function and lower symptom burden are associated with improvement in patients’ QOL over time. The use of certain coping strategies was associated with changes in QOL. These data underscore the need for supportive care interventions to promote effective coping and enhance physical functioning in patients with cGVHD.