A randomized clinical trial on the effectiveness of an intervention to treat psychological distress and improve quality of life after autologous stem cell transplantation.

Annemarie M J Braamse,A W Hoogendoorn,A T F Beekman,P Van Oppen,P C Huijgens,M Van Marwijk Kooy,J Dekker,O J Visser,A D Boenink,C E Eeltink,P Cuijpers,B Van Meijel

doi:10.1007/s00277-015-2509-6

Abstract

Psychological distress contributes to impaired quality of life in hematological cancer patients. Stepped care treatment, in which patients start with the least intensive treatment most likely to work and only receive more intensive interventions if needed, could improve distress. We aimed to evaluate the outcome of stepped care treatment on psychological distress and physical functioning in patients treated with autologous stem cell transplantation for hematological malignancies. In the present study, we performed a randomized clinical trial with two treatment arms: stepped care and care as usual. Baseline assessment and randomization occurred during pre-transplant hospitalization. Stepped care was initiated after 6 weeks, consisting of (1) watchful waiting, (2) Internet-based self-help intervention, and (3) face-to-face counseling/ psychopharmacological treatment/ referral. Follow-up measurements were conducted at 13, 30, and 42 weeks after transplantation. Stepped care (n = 47) and care as usual (n = 48) were comparable on baseline characteristics. The uptake of the intervention was low: 24 patients started with step 1, 23 with step 2, and none with step 3. Percentages of distressed patients ranged from 4.1 to 9.7 %. Ten percent of patients received external psychological or psychiatric care. No statistically significant differences were found between stepped care and care as usual on psychological distress or physical functioning in intention to treat analyses, nor in per protocol analyses. The stepped care program was not effective in decreasing psychological distress. The low intervention uptake, probably related to the low levels of psychological distress, offers an explanation for this outcome. Future research should take into account patients’ specific care needs.Netherlands Trial Registry identifier: NTR1770.

Highlights

For patients diagnosed with hematological malignancies, autologous stem cell transplantation following highdose chemotherapy is a common treatment option
Psychological distress is defined as the presence of elevated depressive or anxiety symptoms
We aimed to evaluate the outcome of stepped care on psychological distress and the quality of life (QOL) domain physical functioning

Summary

Introduction

For patients diagnosed with hematological malignancies, autologous stem cell transplantation (auto-SCT) following highdose chemotherapy is a common treatment option. Before and shortly after auto-SCT, patients generally face impairments in physical, emotional, and role functioning. Ann Hematol (2016) 95:105–114 years, continuous impairments are observed in physical functioning, role functioning, and global QOL [2, 3]. A strong predictor of QOL after auto-SCT is the presence of psychological distress [4, 5]. Psychological distress is defined as the presence of elevated depressive or anxiety symptoms. Previous research shows large variation in the prevalence of depressive and anxiety symptoms in the period from pre-transplant to 1 year post-transplant. Patients with elevated depressive or anxiety symptoms before or during transplantation more often face impaired post-transplant psychological functioning [4, 5, 12, 13] and physical limitations [4]

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