Building Resiliency Among Caregivers of Curvivors and Metavivors: A Pilot randomized Trial

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There is a large and growing population of caregivers (partner/family member/friend) for cancer survivors who have completed curative intent therapy (“curvivors”) and for those who live for many years with metastatic disease (“metavivors”). The emotional distress that caregivers experience is universal, irrespective of their loved one’s diagnosis, stage, treatment, or illness trajectory. Caregivers of both curvivors and metavivors face similar ongoing stressors (e.g., such as fear of cancer recurrence/progression, treatment toxicities and late effects, and difficulty adapting to life changes after cancer) and struggle with elevated distress. There is increasing recognition of reciprocal dynamics between caregiver and survivor distress, underscoring the importance of addressing the psychological, physical, and healthcare utilization needs of both in order to improve health outcomes. Caregivers play a critical role to ensure that survivors adhere to recommended follow-up care as well as attend to their own healthcare needs. While the needs of cancer survivors and their caregivers are well described, there are no interventions specifically focusing on the needs of caregivers of curvivors and metavivors; interventions have focused on caregiving at the end of life and not the chronic, ongoing stress of post-treatment transitions and living with cancer. Furthermore, caregiver interventions have not focused on promoting resiliency skills as a strategy to enhance post-traumatic growth and caregivers’ capacity to manage chronic stress and distress. Our team has developed an evidence-based mind-body group resiliency intervention, the Stress Management and Resiliency Training-Relaxation Response Program (SMART-3RP) and has demonstrated its efficacy for improving resiliency and reducing distress in patients with chronic medical conditions and healthcare clinicians. We propose to conduct a pilot randomized trial of the SMART 3RP vs. enhanced usual care. The population is 48 caregivers and cancer survivor dyads at the Massachusetts General Hospital Cancer Center. We propose to intervene simultaneously, yet focus separately, on improving the resiliency of caregivers and survivors. We will determine the feasibility and acceptability of a SMART-3RP for cancer caregivers and survivors; determine the preliminary efficacy of the SMART-3RP for improving resiliency in caregivers and survivors; and explore effects of SMART-3RP on caregivers’ and survivors’ health care utilization. Our multidisciplinary team has extensive experience in conducting survivor and caregiver outcome research, developing and testing biobehavioral and e-Health interventions, and examining healthcare system utilization. If proven effective, this virtual intervention can be tested in an effectiveness-implementation trial to improve the experience and quality of care for millions of caregivers and cancer survivors.