Telephone-Based Intervention Appears Feasible in Improving Post-HSCT QOL

"We designed PATH with the needs of HSCT survivors in mind. First, PATH is accessible to patients, as they can learn the skills and engage with the intervention over the phone from wherever they are—eliminating the need to travel to the cancer center,” according to lead study author Hermioni L. Amonoo, MD, MPP, MPH.

The Positive Affect for the Transplantation of Hematopoietic stem cell intervention (PATH), an investigational phone-delivered psychology intervention, can be a feasible strategy for improving quality of life (QOL) among survivors of allogeneic hematopoietic stem cell transplantation (HSCT), according to findings from a pilot study published in Journal of the National Comprehensive Cancer Network.¹

Investigators reported that 94% (n = 31/33) of survivors completed at least 6 of 9 PATH sessions, which fulfilled the study’s feasibility end point. Additionally, 91% (n = 30/33; 95% CI, 76%-98%) attended all 9 of these sessions. Intervention with PATH also reached the study’s priori acceptability threshold by demonstrating mean ease scores of 7.40 (95% CI, 6.87-7.92) and mean utility scores of 8.23 (95% CI, 7.83-8.63) on a scale of 0 to 10.

Intervention with PATH elicited small or medium improvements in positive psychological well-being at 18 weeks, which included increases in measures such as gratitude (β = 0.97; d = 0.22), positive affect (β = 2.02; d = 0.27), satisfaction with life (β = 1.82; d = 0.24), and optimism (β = 2.70; d = 0.49). After 9 weeks, survivors who completed intervention with PATH experienced small-sized improvements regarding anxiety (β = –1.43; d = –0.40) and physical function (β = 2.15; d = 0.23) compared with standard care. Moreover, data showed small or medium decreases in anxiety (β = –1.62; d = –0.46), depression (β = –1.04; d = –0.33), post-traumatic stress disorder (PTSD; β = –2.50; d = –0.29), and fatigue (β = –2.54; d = –0.33). PATH also demonstrated improvements in QOL (β = 7.70; d = 0.41) as well as physical function (β = 5.21; d = 0.56) compared with the control treatment.

“We designed PATH with the needs of HSCT survivors in mind. First, PATH is accessible to patients, as they can learn the skills and engage with the intervention over the phone from wherever they are—eliminating the need to travel to the cancer center,” lead study author Hermioni L. Amonoo, MD, MPP, MPH, of Brigham and Women’s Hospital and Dana-Farber Cancer Institute, stated in a press release on this study.²

According to Amonoo, another potential advantage of PATH intervention includes a manual that can guide HSCT survivors on how to make use of the exercise routines and skills they learn during their sessions. This feature, she says, allows survivors to complete weekly exercise activities based on their preferences while reducing the duration of phone sessions to 15 to 20 minutes compared with other psychotherapy strategies that may take place for as long as 60 to 90 minutes each session.

“We [also] carefully curated the intervention sessions based on which activities patients can safely engage in while their immune system recovers following the transplant. For instance, unlike other medical populations, we did not include exercises that focus on community service, which might unnecessarily expose patients to risks,” Amonoo added.²

Investigators designed PATH as a phone-delivered manualized positive psychology intervention containing modules on concepts such as personal strengths, gratitude, and meaning over a 9-week course. 70 survivors of HSCT were assigned 1:1 to receive intervention via PATH (n = 35) or in-person psychological support from social work as standard care (n = 35).

The study’s primary end point was feasibility, which investigators defined as more than 60% of eligible HSCT survivors undergoing enrollment and more than 75% of enrolled survivors finishing at least 6 of 9 PATH sessions. Investigators administered patient-reported outcome (PRO) surveys at baseline and 9 and 18 weeks after initiation of PATH. Self-reported measures included gratitude, positive affect, life satisfaction, optimism, anxiety, depression, PTSD, QOL, physical function, and fatigue.

The mean survivor age was 56.8 years. Additionally, most of the study population was White (91.4%), living with a partner or married (71.4%), attained a college education or more (67.1%), and were on disability or retired (87.1%). Leukemia was the most common diagnosis (68.6%). Investigators reported no significant differences in baseline characteristics between the PATH and standard intervention groups.

References

1. Amonoo HL, Daskalakis E, Wolfe ED, et al. A positive psychology intervention in allogeneic hematopoietic stem cell transplantation survivors (PATH): a pilot randomized clinical trial. J Natl Compr Canc Netw. 2024;22(2D):e237117. doi:10.6004/jnccn.2023.7117
2. Pilot study in JNCCN explores new approach for reducing anxiety and improving quality of life after stem cell transplantation. News release. National Comprehensive Cancer Network. June 11, 2024. Accessed June 12, 2024. https://tinyurl.com/282c4jeu