OBJECTIVES

This pilot study uses data from electronic medical records (EMR) and bone marrow transplantation (BMT) registry to evaluate depression and associated risk factors in the hematopoetic stem cell (HSC) transplant patients at our center.

METHODS

A retrospective review of EMR of autologous (AUTO; N=472) and allogeneic (ALLO; N=259) stem cell transplant patients in UCSD Moores Cancer Center from 2012 to 2017. All diagnoses were defined by ICD-9/ICD-10 codes. Multiple logistic regression and negative binomial modeling were performed to evaluate risk factors and their impact on length of stay in the hospital (LOS) and clinic visit. The analyses were adjusted for age of BMT, gender, diagnosis, comorbidity conditions, GVHD status (for ALLO patients only) and Charlson Comorbidity Index (CCI).

RESULTS

A total of 731 patients with one HSC transplantation of whom 22.3% had depression were identified: AUTO patients (18% depressed [85]); ALLO patients (30.1% depressed [78]). Significant risk factors with depression included infection, COPD, CVD, and ALLO (OR [95%CI; p-value]): 1.535 (1.54, 2.23; 0.025), 2.018 (1.32, 3.09; 0.001), 2.790 (1.57, 4.95; <0.001), and 1.547 (1.06, 2.26; 0.024). For AUTO patients, depression and infection increased LOS (IRR 1.34, 95%CI, 1.05 to 1.71; p = 0.019; IRR 1.33, 95%CI, 1.09 to 1.63; p = 0.005; respectively) and clinic visit (IRR 1.49, 95%CI,1.16 to 1.91; p = 0.002; IRR 1.25, 95%CI, 1.019 to 1.534; p = 0.032, respectively). For ALLO patients, LOS increased with COPD (IRR 1.40; 95%CI, 1.04 to 1.96; p = 0.014) and chronic GVHD (IRR 1.45; 95%CI 1.10 to 1.93; p = 0.009) which increased clinic visit (IRR 1.47; 95%CI, 1.04 to 1.89; p = 0.028).

CONCLUSIONS

HSC patients with depression and associated risk factors had a significant impact of health service utilization. Clinicians and health systems should recognize the importance of providing care in HSC patients with depression and managing comorbid conditions.