EVALUATION OF SYMPTOM DISTRESS IN A BONE-MARROW TRANSPLANT OUTPATIENTENVIRONMENT

OBJECTIVE: TO measure patient perceptions of autologous bone marrow tr ansplantation (ABMT)-associated symptoms in the outpatient setting, as sess the efficacy of the established antiemetic protocol, evaluate pat ient satisfaction, and report patient medication compliance. DESIGN: A prospective, descriptive study of patients with breast cancer who wer e enrolled in an outpatient ABMT program. SETTING: Duke University Aut ologous Bone Marrow Transplantation Program. METHODS: Patient percepti ons of 12 symptoms were measured by the Symptom Distress Scale (SDS) o n the day of admission to the hospital, the day of discharge to the ou tpatient clinic, after bone marrow reinfusion, and before patient rele ase from the clinic. The number of retching and vomiting episodes was recorded by each patient daily, Patient satisfaction was determined by a standardized personal interview conducted prior to discharge. Patie nt compliance was assessed by a review of patient medication documenta tion. RESULTS: Twenty-eight patients were enrolled over 5 months. The median SDS scores for each symptom evaluated revealed that anorexia, n ausea, fatigue, insomnia, and bowel problems were the most distressing symptoms patients experienced in the outpatient ABMT program. Scores for pain, negative outlook, cough, diminished concentration, and chang e in appearance indicated only mild distress associated with these var iables, The total number of vomiting episodes ranged from 1 to 33 tota l episodes per patient per outpatient stay. The percentage of patients experiencing a complete antiemetic response ranged from 24% to 48% ov er the 4 days after chemotherapy but steadily improved thereafter to a peak of 90% 1 week later, Patient satisfaction results showed that pa tients preferred being out of the hospital and reported their anxiety controlled, although most had some problems with the outpatient clinic or medications required, CONCLUSIONS: Loss of appetite, fatigue, and insomnia have been identified as symptoms that are frequently present during the course of the outpatient ABMT program, Mild, intermittent n ausea persists in the outpatient setting for up to 9 days after bone: marrow transplant despite continuous combination antiemetic therapy. P atient interviews confirmed the belief that patients enjoy being out o f the hospital. Medication compliance is more than 90% in this structu red outpatient setting.