Intervention Lowers Stress in Caregivers of Patients Who Need Stem Cell Transplant

Mark Laudenslager, PhD

During cancer treatments, patients are not the only ones who need care.

Caregivers often experience increased stress, and this is especially a concern for caregivers of patients with a blood cancer who have undergone stem cell transplant.

A recent study, published in the journal Bone Marrow Transplantation, found that one-on-one mental health support services, specifically designed for caregivers of those who have undergone allogeneic hematopoietic stem cell transplant (Allo-HSCT), could successfully reduce stress levels.

This clinical trial conducted by the University of Colorado (CU) Cancer Center and funded by the National Cancer Institute evenly randomized 148 caregivers of Allo-HSCT patients, assigning 74 to a group that was offered the study’s psychosocial intervention and 74 to a group that received treatment as usual (which included the availability—but not the requirement—of mental health support services).

In the experimental group, caregivers received eight, one-on-one stress management sessions focused on the following:

• Understanding stress and its physical consequences
• Changing roles as caregivers
• Cognitive behavioral stress management
• Pacing respiration
• Identifying social support

“The first 100 days after a stem cell transplant is a critical period for patients in which caregivers are called upon to deliver around-the-clock care, providing support for patients’ everyday needs and also patients’ emotional health. But who takes care of the caregivers?” said Mark Laudenslager, PhD, investigator at the CU Cancer Center, director of the Behavioral and Endocrinology Laboratory at the CU School of Medicine, and the study’s first author. “We see this as a promising intervention for cancer caregivers in these high-stress situations of home care after acute treatment.”

As part of the caregiver intervention, known as the PsychoEducation, Paced Respiration and Relaxation (PEPRR), caregivers of patients who received stem cell transplant regularly responded to a 14-item questionnaire known as the Perceived Stress Scale (PSS), designed to follow the trajectory of their stress over time. Researchers also measured caregivers’ depression and anxiety using similar, validated questionnaires.

At the 1-month point, the stress of caregivers in the treatment-as-usual group started to rise, whereas stress in the group that received PEPRR continued to decline. Results of the PSS questionnaire administered 3 months after a patient’s stem cell transplant, showed that the stress levels of caregivers who had followed the PEPRR measured even below the average of the general population. At the end of the 100-day study period, mean stress in the PEPRR group was significantly lower than in the treatment-as-usual group. Measures of depression and anxiety were also lower in the PEPRR group.

“Of course, even as caregivers entered the hospital and were offered our study, their stress levels were already elevated,” Laudenslager explained. “We wanted to make sure PEPRR didn’t add any additional caregiver stress, for example, by asking caregivers to schedule additional appointments.

“For that reason, we were pleased to be able to offer our intervention during cancer patients’ follow-up visits. By delivering care to the caregivers at the same time cancer patients were being seen by their doctors, we hoped to minimize the stress of the intervention itself.”

The cost of the program was approximately $500 per caregiver, which is minimal when looked at side-by-side against the cost of Allo-HSCT, which costs up to $200,000, Laudenslager noted.

He and colleagues are currently recruiting for a follow-up study (NCT02037568) funded by Patient-Centered Outcomes Research Institute focused on evaluating improved quality of life in Allo-HSCT patients whose caregivers participate in programs similar to the PEPRR intervention studied in the current trial.

Laudenslager ML, Simoneau TL, Kilbourn K, et al. A randomized control trial of a psychosocial intervention for caregivers of allogeneic hematopoietic stem cell transplant patients: effects on distress [published online ahead of print May 11, 2015]. Bone Marrow Transplant. doi: 10.1038/bmt.2015.104.