Spiritual Well-Being in Long-Term Survivors with Chronic Graft versus Host Disease after Hematopoietic Stem Cell Transplant (HSCT)

Background— Spiritual well-being (Sp-WB) is a resource that supports adaptation and resilience, strengthening quality of life (QOL) in patients with cancer or other chronic illnesses. However, the relationship between Sp-WB and QOL in patients with chronic GVHD (cGVHD) remains unexamined. Methods— 52 participants completed the Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being (FACIT-Sp) questionnaire as part of a multidisciplinary study of cGVHD. Results— Sp-WB was generally high (Mean 37.06, SD 9.5). Those with the lowest Sp-WB had significantly longer time since diagnosis of cGVHD (p=0.05) than those with higher Sp-WB. There were no associations between Sp-WB and demographics, cGVHD severity, or intensity of immunosuppression. Participants with the lowest Sp-WB (N=11) reported inferior physical (p = . 0009), emotional (p = .003), social (p = .027), and functional well-being (p = < 0.0001) as well as lower overall QOL (p = <0.0001) compared to those with higher Sp-WB. They also had inferior QOL (M 54.88, S.E. 4.19) relative to population norms (M=80.1, S.E. 0.55). Differences between those with the lowest and those with better Sp-WB consistently exceeded the minimal clinically significant difference for all subscales and for overall QOL. Controlling for physical, emotional and social well-being, Sp-WB was a significant independent predictor of contentment with QOL. Conclusions— Our results suggest that Sp-WB is an important factor contributing to the QOL of patients with cGVHD. Research is needed to identify factors that diminish Sp-WB and to test interventions designed to strengthen this coping resource in patients experiencing the late-effects of treatment.