Novel intervention reduces anxiety, improves quality of life after stem cell transplant
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A telephone-administered, positive psychology intervention improved the well-being of patients who underwent hematopoietic stem cell transplantation, according to findings published in Journal of the National Comprehensive Cancer Network.
The pilot randomized clinical trial included 70 adults with blood cancer who had undergone HSCT at least 100 days earlier at an academic medical institution.
Researchers randomly assigned study participants to the PATH intervention — the acronym for which stands for positive affect for the transplantation of hematopoietic stem cells — or usual care. The PATH intervention consisted of nine weekly phone sessions on gratitude, personal strengths and meaning.
Hermioni L. Amonoo, MD, MPP, MPH assistant professor of psychiatry at Harvard Medical School, associate program director of psychiatry at Brigham and Women’s Hospital, and attending physician of psychosocial oncology and palliative care at Dana-Farber Cancer Institute — and colleagues evaluated the intervention for feasibility.
Researchers also collected several patient-reported outcomes at baseline, 9 weeks and 18 weeks.
Most (91%) of those assigned to the PATH intervention completed all sessions and stated that they considered the exercises easy to complete and useful.
At 9 weeks, those assigned PATH reported greater improvement in gratitude, anxiety and physical function than those assigned usual care. At 18 weeks, those in the PATH group reported greater improvement in gratitude, positive affect, life satisfaction, optimism, anxiety, depression, PTSD, quality of life, physical function and fatigue.
Healio spoke with Amonoo about the impact of HSCT on patient quality of life, the benefits observed with the PATH intervention and next steps in research.
Healio: What impact does HSCT have on quality of life?
Amonoo: Although HSCT offers many patients with malignant and hematologic conditions a potential for cure, the treatment is intensive and accompanied by numerous physical and psychological symptoms in the setting of a prolonged hospitalization and extended recovery. Physical symptoms include fatigue, and psychological symptoms include depression and anxiety. Unfortunately, these symptoms persist into the extended recovery period following transplantation. The high burden of physical and psychological symptoms results in diminished quality of life and overall physical function, and the social isolation associated with HSCT also contributes to psychological distress symptoms and quality-of-life deficits.
Healio: How did you develop the intervention and what does it entail?
Amonoo: The PATH intervention focuses on gratitude, personal strengths and meaning. PATH was developed after thoroughly reviewing the literature and theoretical frameworks on positive emotions and their impact on clinical outcomes. We also completed a one-arm proof-of-concept study to refine PATH for the HSCT population. Patients receive an intervention manual that describes the content of PATH and the exercises that they have to do every week. Patients can do the exercises on their own and on their own time. During the nine weekly intervention calls, an interventionist introduces the weekly exercises and patients present what they did the preceding week.
Healio: How did you study this intervention and what did you find?
Amonoo: We conducted a randomized clinical trial to study the feasibility and the preliminary efficacy of PATH. This study design was informed by the NIH stage model for intervention development, a well-established framework for behavioral intervention development for oncologic populations. We recruited 70 participants. Half received PATH and half received usual transplant care. We assessed a variety of patient-reported outcomes in both groups to learn more about what outcomes PATH could potentially impact. We found that PATH was feasible and that nine out of 10 patients who received it completed all the intervention sessions. Additionally, we learned promising signals for PATH’s potential effect on anxiety and physical function. This was not an effectiveness study, so we did not gather any data on that.
Healio: What are the potential implications of the findings?
Amonoo: This study sets the foundation for larger multisite randomized clinical trials in diverse patients to establish the efficacy of the intervention on patient-reported outcomes, such as anxiety. Once we know what the impact of the intervention is on outcomes, it has the potential to help patients undergoing HSCT improve their well-being and function.
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For more information:
Hermioni L. AmonooMD, MPP, MPH, can be reached at hermioni_amonoo@dfci.harvard.edu.
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