Health, functional status, and employment of adult survivors of bone marrow transplantation

Objective: To determine the health, functional ability, and employment status of adults who survive bone marrow transplantation. Design: Inception cohort study. Setting: Patients who received transplants at a single referral-based center. Patients: Adults of 18 years of age or older who had received bone marrow transplants at least 6 months previously and who were not in a life-threatening relapse were surveyed a mean of 47 months after transplant (median, 37 months; range, 6 to 149 months). Of 171 eligible patients, 157 were contacted and 135 (86%) responded. Measurements and Main Results: Patients completed a mailed survey. Medical records were also reviewed. Most patients (93%) reported they could do normal activities with minor or no physical problems (Karnofsky scores, ≥ 80%). Global health was described as good to excellent by 67% of subjects. Most perceived social activities (80%) or physical functional abilities (67%) to be unimpaired or only slightly affected. Moderate or severe pain was uncommon (13%). Sixty-five percent had returned to full- or part-time employment, and one third of those who were not employed were attending school. Job discrimination and problems in obtaining insurance were reported by 23% and 39%, respectively. Among those who had been employed before illness, loss of employment was associated with lower social functioning, chronic graft-versus-host disease, greater job discrimination, and female gender using multivariate logistic regression. Conclusions: Most subjects surviving bone marrow transplant reported good to excellent health and functional ability. Three fourths were employed or enrolled in school. These outcomes are comparable to outcomes in survivors of cancer who received less intensive treatments.