Distress and quality of life in patient and caregiver dyads facing stem cell transplant: identifying overlap and unique contributions

• Published in: Supportive care in cancer Vol. 27; no. 6; pp. 2329 - 2337
• Main Authors: Sannes, Timothy S., Simoneau, Teresa L., Mikulich-Gilbertson, Susan K., Natvig, Crystal L., Brewer, Benjamin W., Kilbourn, Kristin, Laudenslager, Mark L.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2019; Springer; Springer Nature B.V
• Subjects: Caregivers; Comparative analysis; Hematopoietic stem cells; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Nursing; Nursing Research; Oncology; Original Article; Pain Medicine; Patients; Quality of life; Rehabilitation Medicine; Sleep; Stem cell transplantation; Stem cells; Transplantation; Transplants & implants; Caregivers; Oncology; Hematology; Dyadic relationships; Dyads; Cancer
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-018-4496-3

Purpose
Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is a demanding treatment requiring caregiver support. The pre-transplant period is particularly stressful. How patient and caregiver dyads respond to these stressors can impact post-transplant outcomes. The purpose of this cross-sectional study was to assess pre-transplant patient and caregiver distress, patient quality of life (pQoL), and simultaneously investigate relationship between caregiver distress, patient distress, and patient QoL.
Methods
We measured caregiver anxiety, depressive symptoms, perceived stress, sleep quality, caregiver burden, and pQoL in148 dyads compared to clinical thresholds or population norms. To reduce comparisons, we created a composite distress score from affective measures. Associations within dyads were examined via correlation and path analysis.
Results
Most dyads scored above norms for psychological measures. Patient distress was positively associated with caregiver distress. Higher caregiver distress significantly predicted poorer pQoL after accounting for the interdependence of patient and caregiver distress. Specifically, patients’ physical functioning was the primary driver of this interrelationship.
Conclusions
Allo-HSCT patients and their caregivers reported elevated distress pre-transplant. Both patient and caregiver distress contributed to pQoL, with patients’ physical functioning accounting significantly for caregiver well-being. Supporting the patient-caregiver dyad before transplantation is a priority for supportive services.