Elko Theresa A, Brown Samantha, Lobaugh Stephanie, Devlin Sean, Jakubowski Ann A, Perales Miguel-Angel, Maloy Molly A, Applebaum Allison J, Giralt Sergio A, Levy Lauren, Schneider Anne, Lin Richard J
Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
J Adv Pract Oncol. 2023 Mar;14(2):127-137. doi: 10.6004/jadpro.2023.14.2.3. Epub 2023 Mar 1.
Older patients with hematologic malignancies are increasingly considered for allogeneic hematopoietic cell transplant (allo-HCT). However, older patients often have increased comorbidities and thus may require an increased level of post-transplant care. These factors can contribute to increased caregiver distress, which has been associated with worsened health outcomes for caregivers and patients. To examine predictors of caregiver distress and support group participation in caregivers of older allo-HCT patients, we retrospectively reviewed charts of 208 patients aged 60 and older who underwent their first allo-HCT at our institution from 2014 through 2016. We systematically characterized and identified the incidence of caregiver distress and attendance in a caregiver support group from the start of conditioning through 1 year post allo-HCT. Evidence of caregiver distress and support group participation was recorded by reviewing clinical and/or social work documentation. We found that 20 caregivers (10%) endorsed stress and 44 caregivers (21%) attended our support group at least once. A patient's prior history of psychiatric diagnosis ( = .046) or the use of potentially inappropriate medications for older adults ( = .046) was found to be associated with caregiver stress. Caregivers who were spouses or partners of patients ( = .048) or caregivers of married patients were more likely to attend the support group ( = .007). While limited by retrospective design and likely underreporting, this study reveals factors associated with caregiver distress in the older allo-HCT caregiver population. This information can help providers identify caregivers at risk for distress and improve caregiver resources, which may improve both caregiver and patient outcomes.
老年血液系统恶性肿瘤患者越来越多地被考虑进行异基因造血细胞移植(allo-HCT)。然而,老年患者往往合并症增多,因此可能需要更高水平的移植后护理。这些因素会导致照顾者的痛苦增加,而这与照顾者和患者的健康状况恶化有关。为了研究老年allo-HCT患者照顾者痛苦的预测因素以及他们参与支持小组的情况,我们回顾性分析了208例60岁及以上患者的病历,这些患者于2014年至2016年在我们机构接受了首次allo-HCT。我们系统地描述并确定了从预处理开始到allo-HCT后1年照顾者痛苦的发生率以及在照顾者支持小组中的参与情况。通过查阅临床和/或社会工作记录来记录照顾者痛苦和参与支持小组的证据。我们发现,20名照顾者(10%)表示有压力,44名照顾者(21%)至少参加过一次我们的支持小组。发现患者既往的精神疾病诊断史(P = 0.046)或使用可能不适合老年人的药物(P = 0.046)与照顾者压力有关。患者的配偶或伴侣担任照顾者(P = 0.048)或已婚患者的照顾者更有可能参加支持小组(P = 0.007)。尽管本研究受回顾性设计的限制且可能存在报告不足的情况,但它揭示了老年allo-HCT照顾者群体中与照顾者痛苦相关的因素。这些信息可以帮助医疗服务提供者识别有痛苦风险的照顾者,并改善照顾者的资源,这可能会改善照顾者和患者的结局。