Psychosocial Intervention for HCT Caregivers May Be Feasible and Reduce Caregiving Burden

January 13, 2020

This study indicated that caregivers saw improved quality of life, reduced caregiving burden, lower anxiety and depression symptoms, and improved self-efficacy and coping skills having received psychosocial intervention.

A study published in Cancer indicated that a brief multimodal psychosocial intervention tailored for caregivers of hematopoietic stem cell transplantation (HCT) recipients may be feasible and could improve quality of life (QOL), mood, coping, and self-efficacy, while simultaneously reducing the caregiving burden during the acute HCT period.1

“Because of the extent of the caregiving burden of this population, more comprehensive multimodal psychosocial interventions spanning the HCT course are needed to promote caregiver coping skills and improve overall [quality of life] while reducing the burden and distress,” the authors wrote.

In this cohort of 92 caregivers, caregivers were randomly assigned to psychosocial intervention (BMT-CARE) or usual care. Caregivers assigned to BMT-CARE met with a trained interventionist in person, via telephone, or via videoconferencing for 6 sessions starting before HCT and continuing up to day 60 after HCT. Of the 45 eligible caregivers enrolled to receive BMT-CARE, 80% attended 50% or more of the intervention sessions, with at least 68.9% completing all 6 intervention sessions. 

Caregivers randomized to BMT-CARE reported improved QOL (B = 6.11; 95% CI, 3.5-8.71; < .001), reduced caregiving burden (= -6.02; 95% CI, -8.49 to -3.55; < .001), lower anxiety (B = -2.18; 95% CI, -3.07 to -1.28; < .001) and depression symptoms (B = -1.23; 95% CI, -1.92 to -0.54; < .001), and improved self-efficacy (B = 7.22; 95% CI, 2.40-12.03; = .003) and coping skills (= 4.83; 95% CI, 3.04-6.94; P < .001) in comparison with the usual-care group. 

Improvements in both QOL and caregiving burden are notable given the extraordinary care demands of HCT recipients, the chronic nature of caregiving for this population, and the critical need to address caregiving burden as a major contributor to caregivers’ moral exhaustion and morbidity, according to the researchers. 

Additionally, enhancing caregivers’ self-efficacy and coping skills may be a key factor in reducing caregivers’ psychological distress and their perceived caregiving burden, potentially leading to improvements in patient health behaviors, such as adherence to complex post-HCT medical regimens. 

Regardless of the recruitment of caregivers at the time of heightened stress before HCT, BMT-CARE was feasible with high enrollment and retention rates. Notably, approximately half of the BMT-CARE intervention sessions took place over the phone or via video conference, allowing for a more scalable and potentially disseminable intervention delivery model.

“Because all transplant centers have access to either psychologists or social workers to support patients undergoing HCT and their caregivers, BMT-CARE has promising potential for scalability in this population,” the authors wrote. 

A future multisite trial is needed to assess the impact of this possibly scalable intervention on long-term patient and caregiver outcomes and to explore potential mediators and moderators of intervention effects on these outcomes, according to the researchers.

HCT is the intravenous infusion of hematopoietic stem and progenitor cells designed to establish marrow and immune function in patients with a variety of acquired and inherited malignant and nonmalignant disorders.2 HCT is a commonly used, and potentially curable, therapy for patients with hematologic malignancies (e.g., leukemia, lymphoma, and myeloma) that requires a prolonged hospitalization and substantial recovery period.

Reference:

1. El-Jawahri A, Jacobs JM, Nelson AM, et al. Multimodal Psychosocial Intervention for Family Caregivers of Patients Undergoing Hematopoietic Stem Cell Transplantation: A Randomized Clinical Trial. Cancer. doi:10.1002/cncr.32680.

2. Cancer Network. Hematopoietic Cell Transplantation. Cancer Network website. Published November 1, 2015. cancernetwork.com/cancer-management/hematopoietic-cell-transplantation. Accessed January 8, 2020.