Reintegration after bone marrow transplantation

OBJECTIVES: This study examines the problem of bone marrow transplantation (BMT) survivors in returning to "normal" life in the community after BMT. MATERIALS AND METHODS: Before being released from The Johns Hopkins Oncology Center, 84 recipients of BMT were interviewed regarding their quality of life and psychosocial adaptation. Survivors were reinterviewed at 6 months and at 1 year post-BMT, producing considerable qualitative data regarding their problems in living. Eighty-four patients who had received BMT completed qualitative interviews and standardized measures before treatment, before the return home, and at 6 and 12 months post-BMT. The interviews were subjected to a content analysis methodology to establish units and categories to examine the body of material. RESULTS: Content analysis of these interviews from the first year after BMT, identified three areas of psychosocial morbidity: 1) physical problems, which included fatigue, appearance, troubles in eating and physical restrictions: 2) psychosocial problems, which included fears and the future, sense of loss of control, anxiety, and depression; and 3) community reintegration problems, which included difficulty returning to former social roles, separation from home, family and friends, difficulty in resuming social relations, dealing with stigmatization, problems with family and children, and financial and employment difficulties. CONCLUSIONS: Identification of these problems for BMT survivors can be used to guide the development of specific materials and services to prepare recipients of BMT and their families for life after the transplant. These qualitative results can also be used to direct the development of assessment tools to identify potential patients and family problems.