![]() In addition, the psychological burden during HSCT can cause negative long-term effects especially in adolescent patients, and can lead to health impairment and unhealthy behavior even years after the disease has been overcome (Gianinazzi et al. There is evidence that experiencing severe anxiety and depression a short time after initial diagnosis can lead to persistence of these symptoms (Myers et al. Thus, psychological stress during HSCT could directly influence the outcome by delaying the regeneration of the immune system. Psychoneuroimmunological studies provide evidence that depression and anxiety can negatively affect the function of the immune system (McGregor et al. This psychological stress can lead to anxiety and depression, which can worsen both the quality of life and survival rate of the patients (Lauer 2015 Wiener et al. Especially in the case of malignant primary diseases, fears of death, or relapse cause further psychological stress (Lazor et al. In both cases, children have to cope for a long period of time with the fact that they are not in their familiar home environment, they cannot maintain the same social contacts as previously, and they also have to endure the side effects associated with the treatment. The psychological impact on children receiving HSCT is similar to that of children receiving chemotherapy (Lazor et al. Hematopoietic stem cell transplantation (HSCT) is a curative therapy for various malignant and nonmalignant diseases (Gratwohl et al. For the parents, the focus is primarily on worry and anxiety, for the patients primarily on exhaustion and worry. This is reflected for the patients both in the DT scores and in the increased cortisol values. In summary, a significantly increased stress level is shown for both the patients and their parents. ![]() Interestingly, the rate of worry among children increased in the post-transplant period and reached its maximum on the day of discharge. Although the pediatric patients experienced mainly exhaustion, especially on the day of transplantation, their parents mainly felt worry and anxiety. The mean cortisol values of the pediatric patients also increased after admission, reaching significant elevated levels above the upper normal limit 1 week after HSCT and on discharge day. There was a significant difference in the parents’ stress levels on the day of HSCT, as compared to their stress levels on other days. The overall stress values of the parents were higher than those of their children. ![]() ResultsĪfter admission to the hospital, the stress levels of the pediatric patients and their parents increased and reached their maximum on the day of HSCT. The patients' cortisol, thyroid stimulating hormone, free triiodothyronine and thyroxine levels were measured regularly during the in-patient stay. In this prospective study, a DT with an attached problem list was used in 40 pediatric patients undergoing HSCT and in one parent of each patient. The distress thermometer (DT) is an easy to use tool for the self-assessment of perceived distress. The activation of the hypothalamic pituitary adrenocortical axis (HPA) can influence the immune system negatively and therefore the overall outcome. Hematopoietic stem cell transplantations (HSCT) are extremely stressful procedures for pediatric patients. ![]()
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