Anxiety and Depression in Patients Recovering from Bone Marrow and Stem Cell Transplants

A stem cell transplant (SCT) or bone marrow transplant (BMT) is a procedure used in treatment of various types of lymphoma, leukemia, and some other cancers and disorders of the blood. These procedures are also referred to as hematopoietic stem cell transplants (HSCT). While this procedure has existed for decades, it came into more common use in the early 1990’s. The effectiveness of transplant varies according to the diagnosis, age, and health of the recipient. The present article aims to give general information about the experience of transplant, and purposely omits statistical information and other specifics. If you are considering bone marrow or stem cell transplant as a treatment option, please consult with your doctor for the most accurate, personally applicable, and up-to-date information. Other information resources can be found at the National Marrow Donor Program and the Leukemia and Lymphoma Society.

Patients who are preparing for a bone marrow or stem cell transplant first receive what is called “conditioning” regimen, which will prepare the body for the transplant. This will typically involve chemotherapy, radiation, or both. This phase of treatment aims to reduce the number of diseased marrow cells, sometimes down to zero. The bone marrow is the center for the body’s immune system. Thus, during and after the “conditioning” phase of treatment, immune functioning is weakened, and precautions are taken to avoid infections. Most cancer centers and some major hospitals will have a unit devoted exclusively to stem cell and bone marrow transplant; these units are specifically equipped to minimize risk of infection to patients with weakened immune systems.

Recipients of bone marrow transplant and stem cell transplant can typically expect a recovery period that takes several months. The first few weeks of the recovery period is spent in the hospital, at a transplant unit. Several weeks after transplant, if the patient is healthy enough, he or she is then discharged from the hospital to continue the recovery process at home or, in some cases, in local residential facilities affiliated with the hospital. During this time, patients are asked to follow a specific diet, and to take other steps to minimize exposure to infection. Patients are often asked to avoid crowded public places, like movie theaters. Some patients find that they are soon able to fully return to their previous lifestyle, while others find that they do not return to prior health or energy levels for extended periods after their transplant.

My own clinical experience with survivors of stem cell or bone marrow transplant has primarily been with people who are 1-2 years after their transplant. After a year of recovery, many people find that they have no, or relatively few, symptoms resulting from their transplant. Others find that some physical symptoms continue to bother them. The most common physical symptoms are fatigue, trouble sleeping, and sexual difficulties.

Research has shown that after a year of recovery, about three quarters of survivors of transplant will experience some symptoms of anxiety or depression. Of these, one third find that the depression or anxiety has a substantial impact on their lives. Some patients describe these difficulties as stemming from the illness itself, as opposed to the transplant. Most patients who receive a bone marrow or stem cell transplant do so because they have a serious illness that has the potential to recur (e.g., leukemia, multiple myeloma, or lymphoma). For some, this possibility is the primary cause of any distress. For others, the shock of their initial diagnosis was a traumatic event that still causes real distress. Other survivors say that the experience of transplant itself has been hard to “put behind them.” Many describe reminders of the transplant and subsequent recovery as causing significant distress. Experiencing such reminders as upsetting is a common phenomenon for survivors of any life-threatening experience, including a diagnosis of cancer and BMT/SCT.

Fortunately, research has also demonstrated that the kinds of distress described above can be effectively addressed with cognitive-behavioral therapy. The aim of this type of therapy is to focus on the thoughts and the behaviors that help maintain symptoms of depression and anxiety, and then to address these symptoms with proven methods. For example, a survivor who is depressed may be experiencing thoughts like, “My leukemia will definitely come back,” or “everything bad always happens to me.” There are many other such possibilities as well. The survivor who entered cognitive-behavioral therapy would learn about the impact of these thoughts, and would be encouraged to explore the factual bases for the thoughts. This type of exploration is always done in collaboration with the therapist.

Other survivors report that reminders of their illness and their transplant cause them significant anxiety and distress. Something as seemingly innocent as a bar of soap might remind the survivor of a soap that was used in the hospital, and thus evoke feelings of anxiety. Sometimes this anxiety has a physiological component to it, and may involve increased breathing rate, heart rate, and muscle tension, e.g. The anxiety may also result in the survivor avoiding the reminder in question. This may not affect the survivor’s daily life. However, if the reminder is commonplace, this avoidance can have a substantial impact. For example, imagine the long-term effects of avoiding soap.

Fortunately, as mentioned above, it is a minority of patients that experience the symptoms of psychological distress just described. For these patients, it is also fortunate that cognitive-behavioral therapy provides a proven option to address the depression and anxiety that can follow SCT/BMT.