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Amonoo HL, Guo M, Boardman AC, Acharya N, Daskalakis E, Deary EC, Waldman LP, Gudenkauf L, Lee SJ, Joffe H, Addington EL, Moskowitz JT, Huffman JC, El-Jawahri A. A Positive Psychology Intervention for Caregivers of Hematopoietic Stem Cell Transplantation Survivors (PATH-C): Initial Testing and Single-Arm Pilot Trial. Transplant Cell Ther 2024; 30:448.e1-448.e14. [PMID: 38266964 PMCID: PMC11009093 DOI: 10.1016/j.jtct.2024.01.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
Caregivers of patients with hematologic malignancies undergoing allogeneic hematopoietic stem cell transplantation (HSCT) play a crucial role in supporting their loved ones through physical, emotional, and practical challenges. This role has been associated with high levels of psychological distress and low levels of positive psychological well-being (PPWB). Positive psychology interventions for caregivers in other disease groups (eg, breast cancer) have been associated with improved outcomes. However, positive psychology interventions that specifically address HSCT caregivers' psychological needs are currently lacking. The goal of this single-arm open-pilot trial was to determine the feasibility and acceptability of the Positive Affect in the Transplantation of Hematopoietic Stem Cells (PATH) intervention for HSCT Caregivers to identify caregiver preferences to tailor PATH for HSCT caregivers. Adult caregivers of HSCT recipients were eligible for PATH during the HSCT recipient's first 100 d post-transplant. We defined, a priori, feasibility as >60% of participants who start the intervention completing ≥6/9 intervention sessions and acceptability as weekly ratings of ease and utility of the PP exercises ≥7/10 on a 10-point Likert Scale (0 = very difficult/not helpful; 10 = very easy/very helpful). We conducted semistructured qualitative exit interviews (n = 15) to explore HSCT caregivers' perception of PATH's content, benefits of PATH, as well as facilitators and barriers to engaging with the intervention. Transcribed interviews were analyzed using framework-guided rapid analysis by 2 coders. The intervention was feasible with 83% (15/18) of caregivers who started the intervention completing ≥6/9 intervention sessions. Among caregivers who completed ≥6/9 intervention sessions, ratings of ease (mean = 8.1; 95% CI: 7.4, 8.7) and utility (mean = 8.3; 95% CI: 7.8, 8.9) also exceeded our a priori threshold of ≥7/10. Caregivers identified benefits of PATH, including identifying and responding to emotions, dedicating time to self-care, and cultivating important relationships. Sociodemographic factors (eg, being retired) and the manualized structure of PATH were cited as facilitators to intervention engagement. Barriers to PATH engagement included lack of time and competing caregiving responsibilities. Caregivers preferred remote intervention delivery within the first 100 d post HSCT. This is the first study to show a 9-wk, phone-delivered positive psychology intervention is feasible in caregivers of allogeneic HSCT recipients. Our findings also underscore the specific preferences of this population for positive psychology interventions. Larger studies are warranted to establish the efficacy of these interventions in addressing persistent unmet psychological needs for HSCT caregivers.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Michelle Guo
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | | | - Nikita Acharya
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Emma C Deary
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lauren P Waldman
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Lisa Gudenkauf
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington
| | - Hadine Joffe
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Elizabeth L Addington
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeff C Huffman
- Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Mass General Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
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2
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Onyeaka HK, Chido-Amajuoyi OG, Daskalakis E, Deary EC, Boardman AC, Basiru T, Muoghalu C, Uwandu Q, Baiden P, Nkemjika S, Aneni K, Amonoo HL. Associations between Health-Related Use of Social Media and Positive Lifestyle Behaviors: Findings from a Representative Sample of US Adult Smokers. Subst Use Misuse 2024; 59:527-535. [PMID: 38037958 PMCID: PMC10922700 DOI: 10.1080/10826084.2023.2287199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Background: Cigarette smokers have elevated cardiovascular risk factors, which contributes significantly to mortality. Although social media is a potential avenue to deliver smoking interventions, its role in health promotion among smokers remains relatively unexplored.Objective: To examine the uptake and impact of health-related social media use in cigarette smokers.Methods: Using data from the 2017-2020 Health Information National Trends Survey, we evaluated differences in health-related social media use between smokers and nonsmokers. Multivariable logistic regression was performed to examine the association between social media use and positive health behaviors.Results: We included 1863 current smokers and 13,560 nonsmokers; Most participants were women (51.0%), White (64.6%), and 49.2% were aged ≥50 years. Smokers who used ≥1 social media site for health-related purposes in the past year were significantly more likely to meet the guideline recommendations for: (i) weekly physical activity (AOR 2.00, 95% CI 1.23-3.24), (ii) daily vegetable intake (AOR 2.48, 95% CI 1.10-5.59), and (iii) weekly strength training (AOR 1.80, 95% CI 1.10-2.94). However, the odds of reporting intentions to quit smoking (AOR 1.81, 95% CI 0.98-3.34) and attempts at smoking cessation (AOR 1.68, 95% CI 0.90-3.12) did not differ by health-related social media use.Conclusion: Smokers use social media for health-related purposes at comparable rates to nonsmokers. While our findings indicate that these platforms present a novel opportunity for health promotion among smokers, future research exploring the utility of social media in smoking cessation is crucial.
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Affiliation(s)
- Henry K Onyeaka
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Onyema G Chido-Amajuoyi
- Department of Epidemiology, The University of Texas Maryland Anderson Cancer Center, Houston, TX, USA
| | | | - Emma C Deary
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Tajudeen Basiru
- Department of Psychiatry, Community Health South Florida, Miami, FL, USA
| | - Chioma Muoghalu
- Department of Pediatrics, Plains Regional Medical Center, Clovis, NM, USA
| | - Queeneth Uwandu
- Department of Internal Medicine, Geisinger Health System, Danville, PA, USA
| | - Philip Baiden
- School of Social Work, The University of Texas at Arlington, Arlington, TX, USA
| | - Stanley Nkemjika
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA
| | - Kammarauche Aneni
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Hermioni L Amonoo
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
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Amonoo HL, Daskalakis E, Deary EC, Guo M, Boardman A, Keane E, Lam JA, Newcomb RA, Gudenkauf LM, Brown LA, Onyeaka HK, Lee SJ, Huffman JC, El-Jawahri A. Gratitude, optimism, and satisfaction with life and patient-reported outcomes in patients undergoing hematopoietic stem cell transplantation. Psychooncology 2024; 33:e6307. [PMID: 38358117 PMCID: PMC10927460 DOI: 10.1002/pon.6307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE Associations between positive psychological well-being (PPWB) and patient-reported outcomes (PROs, e.g., quality of life [QOL]) have yet to be studied extensively in patients with hematologic malignancies who are allogeneic hematopoietic stem cell transplant (HSCT) survivors, despite substantial evidence that PPWB impacts PROs of other medical populations. METHODS We conducted a secondary analysis of cross-sectional data examining the association of PPWB and PROs at day 100 post-transplant among 158 allogeneic HSCT recipients. Optimism, gratitude, life satisfaction, and PROs (i.e., QOL, anxiety, depression, and PTSD symptoms) were assessed using the Life Orientation Test-Revised, Gratitude Questionnaire, Satisfaction with Life Scale, Functional Assessment of Cancer Therapy-Bone Marrow Transplant, Hospital Anxiety and Depression Scale, and Post-Traumatic Stress Disorder (PTSD) Checklist-Civilian Version, respectively. We used linear and multivariate regressions for all analyses and controlled for patient factors. RESULTS Optimism was associated with better QOL (β = 1.46; p < 0.001) and lower levels of anxiety (β = -0.28; p < 0.001), depression (β = -0.31; p < 0.001), and PTSD (β = -0.58; p < 0.001). Gratitude was associated with better QOL (β = 1.11; p < 0.001) and lower levels of anxiety (β = -0.21; p = 0.001), depression (β = -0.14; p = 0.021), and PTSD (β = -0.32; p = 0.032). Finally, satisfaction with life was associated with better QOL (β = 1.26; p < 0.001) and lower levels of anxiety (β = -0.18; p < 0.001), depression (β = -0.21; p < 0.001), and PTSD (β = -0.49; p < 0.001). CONCLUSION Optimism, gratitude, and satisfaction with life were all associated with better QOL and lower levels of psychological distress in allogeneic HSCT survivors. These data support studies to harness PPWB as a therapeutic intervention for this population throughout HSCT recovery.
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Affiliation(s)
- Hermioni L. Amonoo
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Emma C. Deary
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, USA
| | - Michelle Guo
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Emma Keane
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jeffrey A. Lam
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA
| | - Richard A. Newcomb
- Harvard Medical School, Boston, MA, USA
- Mass General Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa M. Gudenkauf
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Lydia A. Brown
- Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia
- La Trobe University, VIC, Australia
| | - Henry K. Onyeaka
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Stephanie J. Lee
- Division of Medical Oncology, Fred Hutchinson Cancer Center, University of Washington, Seattle, WA
| | - Jeff C. Huffman
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Areej El-Jawahri
- Harvard Medical School, Boston, MA, USA
- Mass General Cancer Center, Massachusetts General Hospital, Boston, MA, USA
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Amonoo HL, Deary EC, Wang A, Newcomb RA, Daskalakis E, Weber D, Holmbeck KE, Choe JJ, Nabily A, Cutler C, Traeger LN, El-Jawahri A. Medication Adherence in Patients with Hematologic Malignancies Who Are Hematopoietic Stem Cell Transplantation Survivors: A Qualitative Study. Transplant Cell Ther 2023; 29:620.e1-620.e11. [PMID: 37516379 PMCID: PMC10592303 DOI: 10.1016/j.jtct.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
Medication adherence is critical for optimal health outcomes in patients with hematologic malignancies who have undergone allogeneic hematopoietic stem cell transplants (HSCT). However, this population struggles with medication nonadherence. Research that comprehensively describes the complex patient- and medication-related factors which impact medication adherence in this population is lacking. Hence, we used semistructured qualitative interviews to explore the diverse and complex factors contributing to medication adherence in HSCT recipients. We conducted 30 in-depth interviews with patients who were more than 180 days post-allogeneic HSCT at the Dana-Farber Cancer Institute. The interviews explored the physical, social, psychological, and sociodemographic factors that facilitate or discourage adherence to the post-transplantation medication regimen. Interviews were audio-recorded, transcribed, and coded using NVivo software. Two themes emerged that characterized the barriers patients face with their medication regimen. Patients reported factors outside of their control, such as managing multiple pharmacies, health insurance difficulties, and dosage timing, as significant barriers to medication adherence. Patients also reported barriers within their control, such as familial responsibilities. Important facilitators for medication adherence included caregiver and clinician support, previous experience managing a medication regimen, and tools that aid pill organization and timing. Furthermore, patients reported that although medication side effects and quantity of pills did not directly impact medication adherence, it increased their psychological distress. Facilitators and barriers to medication adherence can be physical, psychological, organizational, and social. There are many aspects of medication regimens that significantly increase patient distress. Hence, supportive interventions to improve medication adherence in patients undergoing HSCT may need to incorporate strategies to manage medication side effects and skills to improve psychological well-being and social support.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Emma C Deary
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Annie Wang
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard A Newcomb
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Daniel Weber
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Katherine E Holmbeck
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Joanna J Choe
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Anisa Nabily
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Corey Cutler
- Harvard Medical School, Boston, Massachusetts; Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lara N Traeger
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychology, University of Miami, Coral Gables, Florida
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Amonoo HL, Lam JA, Daskalakis E, Deary EC, Celano C, Onyeaka HK, Newcomb R, Barata A, Horick N, Cutler C, Pirl WF, Lee SJ, Huffman JC, El-Jawahri A. Positive Psychological Well-Being in Hematopoietic Stem Cell Transplantation Survivors. Transplant Cell Ther 2023; 29:583.e1-583.e9. [PMID: 37442349 PMCID: PMC10529897 DOI: 10.1016/j.jtct.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/26/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023]
Abstract
Positive thoughts and emotions contribute to overall psychological health in diverse medical populations, including patients undergoing HSCT. However, few studies have described positive psychological well-being (eg, optimism, gratitude, flourishing) in patients undergoing HSCT using well-established, validated patient-reported outcome measures. We conducted cross-sectional secondary analyses of baseline data in 156 patients at 100 days post-HSCT enrolled in a randomized controlled trial of a psychological intervention (ClinicalTrials.gov identifier NCT05147311) and a prospective study assessing medication adherence at a tertiary care academic cancer center from September 2021 to December 2022. We used descriptive statistics to outline participant reports of positive psychological well-being (PPWB) using validated measures for optimism, gratitude, positive affect, life satisfaction, and flourishing. The participants had a mean age of 57.4 ± 13.1 years, and 51% were male (n = 79). Many, but not all, participants reported high levels of PPWB (ie, optimism, gratitude, positive affect, life satisfaction, and flourishing), defined as agreement with items on a given PPWB measure. For example, for optimism, 29% of participants did not agree that "overall, I expect more good things to happen to me than bad." Aside from life satisfaction, mean PPWB scores were higher in the HSCT population than in other illness populations. Although many patients with hematologic malignancies undergoing HSCT report high levels of PPWB, a substantial minority of patients reported low PPWB (i.e., no agreement with items on a given PPWB measure). Because PPWB is associated with important clinical outcomes in medical populations, further research should determine whether an intervention to promote PPWB can improve quality of life in HSCT recipients.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Jeffrey A Lam
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts
| | | | - Emma C Deary
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christopher Celano
- Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Henry K Onyeaka
- Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard Newcomb
- Harvard Medical School, Boston, Massachusetts; Mass General Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Anna Barata
- Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Nora Horick
- Mass General Cancer Center, Massachusetts General Hospital, Boston, Massachusetts; Mass General Hospital Biostatistics, Massachusetts General Hospital, Boston, Massachusetts
| | - Corey Cutler
- Harvard Medical School, Boston, Massachusetts; Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - William F Pirl
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Stephanie J Lee
- Division of Medical Oncology, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington
| | - Jeff C Huffman
- Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Mass General Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
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Longley RM, Harnedy LE, Ghanime PM, Arroyo-Ariza D, Deary EC, Daskalakis E, Sadang KG, West J, Huffman JC, Celano CM, Amonoo HL. Peer support interventions in patients with kidney failure: A systematic review. J Psychosom Res 2023; 171:111379. [PMID: 37270909 PMCID: PMC10340538 DOI: 10.1016/j.jpsychores.2023.111379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Peer support has been associated with improved health-related outcomes (e.g., psychological well-being and treatment adherence) among patients with serious, chronic conditions, including kidney disease. Yet, there is little existing research evaluating the effects of peer support programs on health outcomes among patients with kidney failure being treated with kidney replacement therapy. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a systematic review using five databases to assess the effects of peer support programs on health-related outcomes (e.g., physical symptoms, depression) among patients with kidney failure undergoing kidney replacement therapy. RESULTS Peer support in kidney failure was assessed across 12 studies (eight randomized controlled trials, one quasi-experimental controlled trial, and three single-arm trials) with 2893 patients. Three studies highlighted the links between peer support and improved patient engagement with care, while one found peer support did not significantly impact engagement. Three studies showed associations between peer support and improvements in psychological well-being. Four studies underscored the effects of peer support on self-efficacy and one on treatment adherence. CONCLUSIONS Despite preliminary evidence of the positive associations between peer support and health-related outcomes among patients with kidney failure, peer support programs for this patient population remain poorly understood and underutilized. Further rigorous prospective and randomized studies are needed to evaluate how peer support can be optimized and incorporated into clinical care for this vulnerable patient population.
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Affiliation(s)
- Regina M Longley
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Lauren E Harnedy
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States of America
| | - Pia Maria Ghanime
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States of America
| | - Daniel Arroyo-Ariza
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States of America
| | - Emma C Deary
- Brigham and Women's Hospital, Department of Psychiatry, Boston, MA, United States of America
| | - Elizabeth Daskalakis
- Brigham and Women's Hospital, Department of Psychiatry, Boston, MA, United States of America
| | - Katrina G Sadang
- University of California San Francisco School of Medicine, San Francisco, CA, United States of America
| | - Jason West
- Brigham and Women's Hospital, Department of Psychiatry, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Jeff C Huffman
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Christopher M Celano
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Hermioni L Amonoo
- Brigham and Women's Hospital, Department of Psychiatry, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Boston, MA, United States of America.
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Amonoo HL, Daskalakis E, Deary EC, Celano CM, Ghanime PM, Healy BC, Cutler C, Pirl WF, Park ER, Gudenkauf LM, Jim HSL, Traeger LN, LeBlanc TW, El-Jawahri A, Huffman JC. Feasibility of a positive psychology intervention (PATH) in allogeneic hematopoietic stem cell transplantation survivors: Randomized pilot trial design and methods. Contemp Clin Trials 2023; 131:107272. [PMID: 37380022 PMCID: PMC10839810 DOI: 10.1016/j.cct.2023.107272] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/12/2023] [Accepted: 06/25/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Although patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) experience low levels of positive psychological well-being (PPWB), interventions that specifically boost PPWB in this population are lacking. OBJECTIVE To describe the methods of a randomized controlled trial (RCT) designed to assess the feasibility, acceptability, and preliminary efficacy of a positive psychology intervention (PATH) tailored to the unique needs of HSCT survivors and aimed to decrease anxiety and depression symptoms and boost quality of life (QOL). METHODS We will conduct a single-institution RCT of a novel nine-week phone-delivered manualized positive psychology intervention compared to usual transplant care in 70 HSCT survivors. Allogeneic HSCT survivors at 100 days post-HSCT are eligible for the study. The PATH intervention, tailored to the needs of HSCT survivors in the acute recovery phase, focuses on gratitude, strengths, and meaning. Our primary aims are to determine feasibility (e.g., session completion, rate of recruitment) and acceptability (e.g., weekly session ratings). Our secondary aim is to test the preliminary efficacy of the intervention on patient-reported outcomes (e.g., anxiety symptoms, QOL). DISCUSSION If the PATH intervention is feasible, a larger randomized, controlled efficacy trial will be indicated. Additionally, we anticipate that the results from this RCT will guide the development of other clinical trials and larger efficacy studies of positive psychology interventions in vulnerable oncological populations beyond HSCT.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | | | - Emma C Deary
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher M Celano
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Pia Maria Ghanime
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Brian C Healy
- Harvard Medical School, Boston, MA, USA; Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Corey Cutler
- Harvard Medical School, Boston, MA, USA; Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
| | - William F Pirl
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Elyse R Park
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa M Gudenkauf
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Lara N Traeger
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Thomas W LeBlanc
- Duke Cancer Institute, Durham, NC, USA; Department of Medicine, Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA
| | - Areej El-Jawahri
- Harvard Medical School, Boston, MA, USA; Mass General Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - Jeff C Huffman
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Deary EC, Daskalakis E, Abrahm JL, Morris SE, Amonoo HL. At a Loss: Patient Deaths and Clinical Research Coordinators. J Clin Oncol 2023; 41:3072-3073. [PMID: 37098231 PMCID: PMC10414706 DOI: 10.1200/jco.23.00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/13/2023] [Accepted: 02/23/2023] [Indexed: 04/27/2023] Open
Affiliation(s)
- Emma C. Deary
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
| | | | - Janet L. Abrahm
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Sue E. Morris
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - Hermioni L. Amonoo
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
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9
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Amonoo HL, Markovitz NH, Johnson PC, Kwok A, Dale C, Deary EC, Daskalakis E, Choe JJ, Yamin N, Gothoskar M, Cronin KG, Fernandez-Robles C, Pirl WF, Chen YB, Cutler C, Lindvall C, El-Jawahri A. Delirium and Healthcare Utilization in Patients Undergoing Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2023; 29:334.e1-334.e7. [PMID: 36736782 PMCID: PMC10149603 DOI: 10.1016/j.jtct.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/04/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
Delirium, a common neuropsychiatric syndrome among hospitalized patients, has been associated with significant morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). Although delirium is often reversible with prompt diagnosis and appropriate management, timely screening of hospitalized patients, including HSCT recipients at risk for delirium, is lacking. The association between delirium symptoms and healthcare utilization among HSCT recipients is also limited. We conducted a retrospective analysis of 502 hospitalized patients admitted for allogeneic or autologous HSCT at 2 tertiary care hospitals between April 2016 and April 2021. We used Natural Language Processing (NLP) to identify patients with delirium symptoms, as defined by an NLP-assisted chart review of the electronic health record (EHR). We used multivariable regression models to examine the associations between delirium symptoms, clinical outcomes, and healthcare utilization, adjusting for patient-, disease-, and transplantation-related factors. Overall, 44.4% (124 of 279) of patients undergoing allogeneic HSCT and 39.0% (87 of 223) of those undergoing autologous HSCT were identified as having delirium symptoms during their index hospitalization. Two-thirds (139 of 211) of the patients with delirium symptoms were prescribed treatment with antipsychotic medications. Among allogeneic HSCT recipients, delirium symptoms were associated with longer hospital length of stay (β = 7.960; P < .001), fewer days alive and out of the hospital (β = -23.669; P < .001), and more intensive care unit admissions (odds ratio, 2.854; P = .002). In autologous HSCT recipients, delirium symptoms were associated with longer hospital length of stay (β = 2.204; P < .001). NLP-assisted EHR review is a feasible approach to identifying hospitalized patients, including HSCT recipients at risk for delirium. Because delirium symptoms are negatively associated with health care utilization during and after HSCT, our findings underscore the need to efficiently identify patients hospitalized for HSCT who are at risk of delirium to improve their outcomes. © 2023 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Netana H Markovitz
- Harvard Medical School, Boston, Massachusetts; Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - P Connor Johnson
- Harvard Medical School, Boston, Massachusetts; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Anne Kwok
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ciara Dale
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emma C Deary
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Joanna J Choe
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Nikka Yamin
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Maanasi Gothoskar
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Katherine G Cronin
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Carlos Fernandez-Robles
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - William F Pirl
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Yi-Bin Chen
- Harvard Medical School, Boston, Massachusetts; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Corey Cutler
- Harvard Medical School, Boston, Massachusetts; Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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10
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Amonoo HL, Johnson PC, Nelson AM, Clay MA, Daskalakis E, Newcomb RA, Deary EC, Mattera EF, Yang D, Cronin K, Boateng K, Lee SJ, LeBlanc TW, El-Jawahri A. Coping in caregivers of patients with hematologic malignancies undergoing hematopoietic stem cell transplantation. Blood Adv 2023; 7:1108-1116. [PMID: 36398978 PMCID: PMC10111355 DOI: 10.1182/bloodadvances.2022008281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/10/2022] [Accepted: 09/29/2022] [Indexed: 11/21/2022] Open
Abstract
Caregivers of patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT) must cope with substantial caregiving burden, high rates of psychological distress, and diminished quality of life (QOL). However, data describing coping strategies before HSCT and the association between coping, QOL, and psychological outcomes in this population are lacking. We conducted a secondary analysis of data collected during a multisite randomized clinical trial of a supportive care intervention in HSCT recipients and their caregivers. Caregivers completed the Brief COPE, Hospital Anxiety and Depression Scale, and the Caregiver Oncology Quality of Life Questionnaire to measure coping strategies, psychological distress, and QOL, respectively. We grouped coping into 2 higher-order domains: approach-oriented (ie, emotional support and active coping) and avoidant (ie, self-blame and denial). We used the median split method to describe the distribution of coping and multivariate linear regression models to assess the relationship between coping and caregiver outcomes. We enrolled 170 caregivers, with a median (range) age of 53 (47-64) years. Most were White (87%), non-Hispanic (96%), and female (77%). Approach-oriented coping was associated with less anxiety (β = -0.210, P = .003), depression symptoms (β = -0.160, P = .009), and better QOL (β = 0.526, P = .002). In contrast, avoidant coping was associated with more anxiety (β = 0.687, P<.001), depression symptoms (β = 0.579, P < .001), and worse QOL (β = -1.631, P < .001). Our findings suggest that coping is related to distress and QOL among caregivers of HSCT recipients even before transplant. Hence, caregivers of patients with hematologic malignancies undergoing HSCT may benefit from resources that facilitate adaptive coping with the demands of caregiving.
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Affiliation(s)
- Hermioni L. Amonoo
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | - P. Connor Johnson
- Harvard Medical School, Boston, MA
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Ashley M. Nelson
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Madison A. Clay
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Richard A. Newcomb
- Harvard Medical School, Boston, MA
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Emma C. Deary
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
| | - Elizabeth F. Mattera
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Daniel Yang
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Katherine Cronin
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Kofi Boateng
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Stephanie J. Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, and Division of Medical Oncology, University of Washington, Seattle, WA
| | - Thomas W. LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Areej El-Jawahri
- Harvard Medical School, Boston, MA
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
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11
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Onyeaka HK, Sadang KG, Daskalakis E, Deary EC, Desir MC, Asante KO, Zambrano J, François J, Abrahm JL, Amonoo HL. US Immigrant Utilization and Perceptions of Palliative Care. J Pain Symptom Manage 2023; 65:e233-e236. [PMID: 36423802 DOI: 10.1016/j.jpainsymman.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/28/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Henry K Onyeaka
- Harvard Medical School (H.O., M.D., J.Z., J.F., J.A., H.A.), Boston Massachusetts, USA; Department of Psychiatry (H.O., J.Z.), Massachusetts General Hospital, Boston Massachusetts, USA
| | - Katrina Grace Sadang
- (K.S.) Harvard T.H. Chan School of Public Health, Boston Massachusetts, USA; (K.S.) University of California San Francisco School of Medicine, San Francisco California, USA
| | - Elizabeth Daskalakis
- Department of Psychiatry (E.D., M.D., J.F., H.A.), Brigham and Women's Hospital, Boston Massachusetts, USA
| | - Emma C Deary
- Department of Psychiatry (E.D., M.D., J.F., H.A.), Brigham and Women's Hospital, Boston Massachusetts, USA
| | - Marie C Desir
- Harvard Medical School (H.O., M.D., J.Z., J.F., J.A., H.A.), Boston Massachusetts, USA; Department of Psychiatry (E.D., M.D., J.F., H.A.), Brigham and Women's Hospital, Boston Massachusetts, USA
| | - Kwaku Oppong Asante
- Department of Psychology (K.A.), University of Ghana, Legon, Accra, Ghana; Department of Psychology (K.A.), University of the Free State, Bloemfontein, South Africa
| | - Juliana Zambrano
- Harvard Medical School (H.O., M.D., J.Z., J.F., J.A., H.A.), Boston Massachusetts, USA; Department of Psychiatry (H.O., J.Z.), Massachusetts General Hospital, Boston Massachusetts, USA
| | - Josie François
- Harvard Medical School (H.O., M.D., J.Z., J.F., J.A., H.A.), Boston Massachusetts, USA; Department of Psychiatry (E.D., M.D., J.F., H.A.), Brigham and Women's Hospital, Boston Massachusetts, USA
| | - Janet L Abrahm
- Harvard Medical School (H.O., M.D., J.Z., J.F., J.A., H.A.), Boston Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (J.A., H.A.), Dana-Farber Cancer Institute, Boston Massachusetts, USA; (J.A.) Division of Palliative Medicine, Brigham and Women's Hospital, Boston Massachusetts, USA
| | - Hermioni L Amonoo
- Harvard Medical School (H.O., M.D., J.Z., J.F., J.A., H.A.), Boston Massachusetts, USA; Department of Psychiatry (E.D., M.D., J.F., H.A.), Brigham and Women's Hospital, Boston Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care (J.A., H.A.), Dana-Farber Cancer Institute, Boston Massachusetts, USA.
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12
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Amonoo HL, Markovitz NH, Johnson PC, Dale C, Deary EC, Daskalakis E, Choe J, Yamin N, Gothoskar M, Kwok A, Fernandez-Robles C, Pirl W, Chen DYB, Cutler DC, Lindvall C, El-Jawahri AR. Delirium in Patients Undergoing Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00261-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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13
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Onyeaka HK, Muoghalu C, Deary EC, Ajayi KV, Kyeremeh E, Dosunmu TG, Jawla M, Onaku E, Nwani SP, Asante KO, Amonoo HL. The Role of Health Information Technology in Improving Awareness of Human Papillomavirus and Human Papillomavirus Vaccine Among U.S. Adults. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Henry K. Onyeaka
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Chioma Muoghalu
- Department of Clinical Informatics, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Presbyterian Hospital, Clovis, New Mexico, USA
| | - Emma C. Deary
- Department of Psychiatry, Brigham and Women Hospital, Boston, Massachusetts, USA
| | - Kobi V. Ajayi
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA
- Laboratory of Community Health Evaluation Science and Systems (CHESS), Texas A&M University, College Station, Texas, USA
| | - Emmanuel Kyeremeh
- Department of Sociology, University of Toronto, Toronto, Ontario, Canada
| | | | - Muhammed Jawla
- Department of Epidemiology, Louisiana State University School of Health Sciences, New Orleans, Louisiana, USA
| | | | - Somtochi P Nwani
- Faculty of Pharmaceutical Sciences, University of Nigeria, Enugu, Nigeria
| | | | - Hermioni L. Amonoo
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women Hospital, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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14
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Amonoo HL, Daskalakis E, Deary EC, Bodd MH, Reynolds MJ, Nelson AM, Newcomb R, Dhawale TM, Yang D, Luger SM, Gustin JL, Brunner A, Fathi AT, LeBlanc TW, El-Jawahri A. Relationship Between Longitudinal Coping Strategies and Outcomes in Patients With Acute Myeloid Leukemia. J Natl Compr Canc Netw 2022; 20:1116-1123. [DOI: 10.6004/jnccn.2022.7045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 06/15/2022] [Indexed: 11/06/2022]
Abstract
Background: Patients with acute myeloid leukemia (AML) face an abrupt life-threatening illness and experience immense physical and psychological symptoms. However, no data describe how patients with AML cope longitudinally with their illness or the relationship between longitudinal coping and outcomes. Methods: We conducted a secondary analysis of longitudinal data from 160 patients with high-risk AML enrolled in a supportive care intervention trial to describe coping strategies longitudinally across the illness course. We used the Brief COPE questionnaire, the Hospital Anxiety and Depression Scale, the Post-Traumatic Stress Disorder (PTSD) Checklist-Civilian Version, and the Functional Assessment of Cancer Therapy-Leukemia to measure coping strategies, psychological distress, and quality of life (QoL) at baseline and at weeks 2, 4, 12, and 24 after diagnosis. Electronic health records were used to assess healthcare utilization and end-of-life (EoL) outcomes, and multivariate analyses were used to assess the relationship between coping and outcomes. Results: Longitudinal utilization of approach-oriented coping strategies was significantly associated with less distress (anxiety: β, –0.18; P<.001; depression symptoms: β, –0.42; P<.001; PTSD symptoms: β, –0.60; P<.001) and better QoL (β, 2.00; P<.001). Longitudinal utilization of avoidant coping strategies was significantly associated with greater distress (anxiety: β, 0.64; depression symptoms: β, 0.54; PTSD symptoms: β, 2.13; P<.001 for all) and worse QoL (β, –4.27; P<.001). Although the use of approach-oriented and avoidant coping strategies was not significantly associated with hospitalization, chemotherapy administration, or hospice use in the last 30 days of life, approach-oriented coping was associated with lower odds of ICU admissions (odds ratio, 0.92; P=.049). Conclusions: Longitudinal use of approach-oriented coping strategies was associated with less psychological distress, better QoL, and a lower likelihood of ICU admission, suggesting a possible target for supportive oncology interventions. Coping strategies did not impact EoL outcomes, and further research is needed to elucidate which patient factors impact EoL decision-making.
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Affiliation(s)
- Hermioni L. Amonoo
- 1Department of Psychiatry, Brigham and Women’s Hospital,
- 2Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, and
- 3Harvard Medical School, Boston, Massachusetts
| | | | - Emma C. Deary
- 1Department of Psychiatry, Brigham and Women’s Hospital,
| | - Monica H. Bodd
- 4Duke University School of Medicine, Durham, North Carolina
| | | | - Ashley M. Nelson
- 3Harvard Medical School, Boston, Massachusetts
- 6Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard Newcomb
- 5Division of Hematology and Oncology, Department of Medicine, and
| | | | - Daniel Yang
- 5Division of Hematology and Oncology, Department of Medicine, and
| | - Selina M. Luger
- 7Division of Hematology Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jillian L. Gustin
- 8Division of Palliative Medicine, The James Cancer Hospital, Ohio State University, Columbus, Ohio; and
| | - Andrew Brunner
- 3Harvard Medical School, Boston, Massachusetts
- 5Division of Hematology and Oncology, Department of Medicine, and
| | - Amir T. Fathi
- 3Harvard Medical School, Boston, Massachusetts
- 5Division of Hematology and Oncology, Department of Medicine, and
| | - Thomas W. LeBlanc
- 9Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Areej El-Jawahri
- 3Harvard Medical School, Boston, Massachusetts
- 5Division of Hematology and Oncology, Department of Medicine, and
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15
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Amonoo HL, Deary EC, Harnedy LE, Daskalakis E, Goldschen L, Desir MC, Newcomb RA, Wang AC, Boateng K, Nelson AM, Jawahri AE. It Takes a Village: The Importance of Social Support after Hematopoietic Stem Cell Transplantation, A Qualitative Study. Transplant Cell Ther 2022; 28:400.e1-400.e6. [PMID: 35577321 DOI: 10.1016/j.jtct.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/12/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND/OBJECTIVE Social support is essential to the recovery of patients who have undergone hematopoietic stem cell transplants (HSCT). We undertook a qualitative study to explore the specific sources and benefits of social support as experienced by HSCT recipients, as well as their unmet social support needs. METHODS We conducted semi-structured interviews with 25 patients who had undergone HSCT and were recruited from the Dana Farber Cancer Institute's HSCT database. The interviews explored the sources of support patients receive, the type of assistance social support networks provide to patients, and unmet needs of social support. Interviews were audio-recorded, transcribed, and coded using the Dedoose software. RESULTS The median (range) age of participants was 63 (22-73) years, and 13 (52%) were female, 20 (80%) were White, and 9 (36%) were diagnosed with acute myeloid leukemia. Participants reported receiving a majority of support from immediate family and close friends, with the primary benefits of social support including help with essential daily tasks, household chores, and receipt of emotional support. Participants reported occasional support from other patients but highlighted a desire for increased connection with patients who have undergone the same treatment. Participants also communicated a desire to have more guidance on how to optimize the support they do receive and the need for more educational resources for caregivers and supporters to enhance understanding of the HSCT process and lessen patient burden. CONCLUSION Participants rely on support from their family, friends, and other social connections for essential aspects of their recovery and daily living following HSCT. While there are many benefits to these relationships, patients emphasized the need for more guidance and resources to facilitate the aid and support they receive post-transplant.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychiatry, Brigham and Women's Hospital, Boston MA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston MA; Harvard Medical School, Boston MA; Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston MA.
| | - Emma C Deary
- Department of Psychiatry, Brigham and Women's Hospital, Boston MA
| | - Lauren E Harnedy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | | | - Lauren Goldschen
- Department of Psychiatry, Brigham and Women's Hospital, Boston MA; Harvard Medical School, Boston MA
| | - Marie C Desir
- Department of Psychiatry, Brigham and Women's Hospital, Boston MA; Harvard Medical School, Boston MA
| | - Richard A Newcomb
- Harvard Medical School, Boston MA; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston MA
| | - Annie C Wang
- Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston MA
| | - Kofi Boateng
- Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston MA
| | - Ashley M Nelson
- Harvard Medical School, Boston MA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston MA
| | - Areej El Jawahri
- Harvard Medical School, Boston MA; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston MA; Cancer Outcomes Research and Education Program, Massachusetts General Hospital Cancer Center, Boston MA
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16
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Amonoo HL, El-Jawahri A, Deary EC, Traeger LN, Cutler CS, Antin JA, Huffman JC, Lee SJ. Yin and Yang of Psychological Health in the Cancer Experience: Does Positive Psychology Have a Role? J Clin Oncol 2022; 40:2402-2407. [PMID: 35377731 PMCID: PMC9467675 DOI: 10.1200/jco.21.02507] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA.,Department of Psychiatry, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Areej El-Jawahri
- Harvard Medical School, Boston, MA.,Mass General Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Emma C Deary
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
| | - Lara N Traeger
- Harvard Medical School, Boston, MA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Corey S Cutler
- Harvard Medical School, Boston, MA.,Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA
| | - Joseph A Antin
- Harvard Medical School, Boston, MA.,Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA
| | - Jeff C Huffman
- Harvard Medical School, Boston, MA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Stephanie J Lee
- Division of Medical Oncology, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
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17
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Lane MKM, Garedew M, Deary EC, Coleman CN, Ahrens-Víquez MM, Erythropel HC, Zimmerman JB, Anastas PT. What to Expect When Expecting in Lab: A Review of Unique Risks and Resources for Pregnant Researchers in the Chemical Laboratory. Chem Res Toxicol 2022; 35:163-198. [PMID: 35130693 PMCID: PMC8864617 DOI: 10.1021/acs.chemrestox.1c00380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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Pregnancy presents a unique risk
to chemical researchers due to
their occupational exposures to chemical, equipment, and physical
hazards in chemical research laboratories across science, engineering,
and technology disciplines. Understanding “risk” as
a function of hazard, exposure, and vulnerability, this review aims
to critically examine the state of the science for the risks and associated
recommendations (or lack thereof) for pregnant researchers in chemical
laboratories (labs). Commonly encountered hazards for pregnant lab
workers include chemical hazards (organic solvents, heavy metals,
engineered nanomaterials, and endocrine disruptors), radiation hazards
(ionizing radiation producing equipment and materials and nonionizing
radiation producing equipment), and other hazards related to the lab
environment (excessive noise, excessive heat, psychosocial stress,
strenuous physical work, and/or abnormal working hours). Lab relevant
doses and routes of exposure in the chemical lab environment along
with literature and governmental recommendations or resources for
exposure mitigation are critically assessed. The specific windows
of vulnerability based on stage of pregnancy are described for each
hazard, if available. Finally, policy gaps for further scientific
research are detailed to enhance future guidance to protect pregnant
lab workers.
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Affiliation(s)
- Mary Kate M Lane
- Department of Chemical and Environmental Engineering, Yale University, New Haven, Connecticut 06511, United States.,Center for Green Chemistry and Green Engineering, Yale University, New Haven, Connecticut 06511, United States
| | - Mahlet Garedew
- Center for Green Chemistry and Green Engineering, Yale University, New Haven, Connecticut 06511, United States.,School of the Environment, Yale University, New Haven, Connecticut 06511, United States
| | - Emma C Deary
- Department of Anthropology, Wellesley College, Wellesley, Massachusetts 02481, United States
| | - Cherish N Coleman
- Department of Biology, University of Detroit Mercy, Detroit, Michigan 48221, United States
| | - Melissa M Ahrens-Víquez
- Department of Chemical and Environmental Engineering, Yale University, New Haven, Connecticut 06511, United States
| | - Hanno C Erythropel
- Department of Chemical and Environmental Engineering, Yale University, New Haven, Connecticut 06511, United States.,Center for Green Chemistry and Green Engineering, Yale University, New Haven, Connecticut 06511, United States
| | - Julie B Zimmerman
- Department of Chemical and Environmental Engineering, Yale University, New Haven, Connecticut 06511, United States.,Center for Green Chemistry and Green Engineering, Yale University, New Haven, Connecticut 06511, United States.,School of the Environment, Yale University, New Haven, Connecticut 06511, United States
| | - Paul T Anastas
- Center for Green Chemistry and Green Engineering, Yale University, New Haven, Connecticut 06511, United States.,School of the Environment, Yale University, New Haven, Connecticut 06511, United States.,School of Public Health, Yale University, New Haven, Connecticut 06510, United States
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18
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Affiliation(s)
- Emma C Deary
- Wellesley College, Wellesley, Massachusetts (E.C.D.)
| | - Joseph S Ross
- Yale School of Medicine, New Haven, Connecticut (J.S.R.)
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, New Haven, Connecticut (K.N.)
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