Many patients who receive hematopoietic stem cell transplantation (HSCT) for blood cancer suffer from stress related to their treatments. Now, a new phone-based positive psychology program called Positive Affect for the Transplantation of Hematopoietic stem cells intervention (PATH), has shown that it can alleviate the stress these patients experience as a result of their hematopoietic stem cell treatments. Results of a study evaluating PATH by researchers from the Brigham and Women’s Hospital and the the Dana-Farber Cancer Institute were published this week in the June issue of JNCCN—Journal of the National Comprehensive Cancer Network.
“Psychological well-being is vital to every aspect of treatment and recovery following hematopoietic stem cell transplantation (HSCT),” the study authors write. “Although HSCT is a potentially curative treatment for patients with malignant hematologic conditions, HSCT survivors grapple with enormous physical (eg, fatigue) and psychological symptoms (eg, anxiety) due to high-dose chemotherapy, with significant toxicities and potentially life-threatening complications during a prolonged hospitalization in physical isolation.”
Patients who will receive HSCT for their cancers face an arduous treatment regimen. HSCT entails the infusion of stem cells from a donor into a patient with matching human leukocyte antigen types, with patients receiving these treatments spending four or more weeks in the hospital for the transplant and subsequent recovery period.
The hospitalization period is usually kicked off by conditioning by high-dose chemotherapy and occasionally total body radiation. While there may be immune benefits from the treatments, there are also immune-related side effects such as graft-versus-host disease (GVHD), which can cause damage of host organs by the donor graft cells. Additionally, the intensity of the chemotherapy combined with GVHD can lead to a range of acute—and chronic—side effects infections such as bleeding, nausea, vomiting, diarrhea, fatigue, rashes, and sometimes fatal complications.
The result of the physically taxing treatments and long periods spent in the hospital leads to a high number of HSCT patients experiencing levels of distress. Previous studies have shown that as many as four-in-ten patients report clinically significant depression and anxiety symptoms during the HSCT hospitalization.
PATH was created to address this unmet need of HSCT patients, to improve their quality of life during and after treatment by improving their positive psychological well-being (PPWB). The program provides nine weekly one-on-one 15–20-min phone sessions—along with other resources—to improve psychological distress symptoms and quality of life in HSCT survivors. PATH comprises a variety of weekly positive psychology exercises focused on gratitude, personal strengths and meaning.
For this study, which was conducted from August 2021 to August 2022, the researchers enrolled 70 adult patients with blood cancers who had received stem cell treatments. The participants were randomized into two groups, a PATH arm and a control arm with the intervention occurring 100 post treatment.
Of those in the PATH arm, 94% completed at least six of nine sessions and 91% completed all nine with patients reporting positive outcomes immediately after the completion of the program and again reporting positive effects at week 18.
“Cancer care providers should consider the potential benefits of psychosocial resources and interventions like PATH that focus on enriching positive emotions to bolster their patients’ well-being,” noted lead author Hermioni L. Amonoo, MD, a physician/scientist in the department of psychology at Brigham and Women’s. “While the active identification and treatment of psychological distress, like anxiety, in patients with cancer are crucial, encouraging patients to engage in simple, structured, and systematic exercises aimed at fostering positive thoughts and emotions, such as gratitude, has the potential to enhance well-being as well.”
A key feature of the program is the relative brevity of the phone sessions that last for only 15–20 minutes compared with traditional cognitive therapy sessions which typically run for 60–90 minutes.
Added Jessica Vanderlan, PhD, a licensed clinical psychologist, the Siteman Cancer Center at Barnes-Jewish Hospital and the Washington University School of Medicine, who was not involved in this research: “Development of clinical interventions that are brief and delivered by phone could greatly improve patient access to care This type of accessibility is important in an oncology population, especially in acute recovery periods with many competing demands and physical symptoms.”
