Does Desire to Pursue Pleasurable Activities Matter? The Impact of Pre-transplant Anhedonia on Quality of Life and Fatigue in Hematopoietic Stem Cell Transplantation.

Anhedonia, the loss of the capacity to experience pleasure, is subjectively and biologically distinct from depressed mood. Few studies have specifically examined the association of pre-transplant anhedonia with key functional outcomes (e.g., health-related quality of life; QOL) in patients with hematologic malignancies who have received hematopoietic stem cell transplantation (HSCT).Among 248 HSCT patients enrolled in two intervention trials, we examined the associations between pre-transplant anhedonia and both QOL and fatigue at 2 weeks and 6 months post-transplant. Across time points, patients completed the Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Therapy-Bone Marrow Transplant, and Functional Assessment of Cancer Therapy-Fatigue subscale, which we used to measure depressive symptoms, QOL and fatigue, respectively. Pre-transplant anhedonia was assessed via the corresponding item in the Patient Health Questionnaire-9. The Functional Assessment of Cancer Therapy-Bone Marrow Transplant and the Functional Assessment of Cancer Therapy-Fatigue subscale were used to measure QOL and fatigue. Associations between pre-transplant anhedonia and outcomes were assessed via regression analyses adjusting for age, gender, transplant type, and intervention group.39.5% (n=98) of patients reported pre-transplant anhedonia. Of the patients who reported pre-transplant anhedonia, 61% (n=60) did not meet criteria for elevated depressive symptoms. Pre-transplant anhedonia was negatively associated with QOL at 2 weeks (B=-17.21; 95% CI, -23.05 to -11.30; p<.001) and at 6 months (B=-15.10; 95% CI, -21.51 to -8.69; p<.001). Pre-transplant anhedonia was also negatively associated with fatigue (2 weeks: B=-9.35; 95% CI, -12.47 to -6.22; p<.001; 6 months: B=-5.68; 95% CI, -9.07 to -2.28; p=.001). The association between pre-transplant anhedonia and QOL and fatigue remained significant after adjusting for depression scores.Pre-transplant anhedonia is negatively and significantly associated with QOL and fatigue in HSCT patients. These findings underscore the need to incorporate anhedonia assessment in the evaluation and management of psychological distress in HSCT patients.