Psychoeducation for BMT caregivers: Biobehavioral markers and outcome

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DESCRIPTION (provided by applicant): Caregiving represents a life challenge with a number of psychological and physiological consequences leading to increased morbidly and mortality. Developing interventions to care for the caregiver is vital. According to the National Cancer Institute (NCI) in 2006, there were more than 11 million cancer survivors in the US. The NCI recognizes that "...family members, friends, and caregivers are also part of the survivorship experience..." Caregivers of patients receiving allogeneic blood or marrow transplants (BMT) for immunologic, blood, and other disorders are faced with a distinctly stressful experience. Approval for an allogeneic BMT requires the presence of a 24 hour/day caregiver for at least 100 days and often longer. The caregiver is an integral aspect of the patient's recovery process. Although caregivers may reduce medical costs associated with patient care, the impact on the caregiver is substantial leading to lost work, financial burden, and increased medical and mental health problems for the caregiver. Although a number of psychosocial interventions have targeted cancer patients, only a few have targeted cancer caregivers and even fewer have followed longitudinally biomarkers of health in association with these interventions. The parent study (CA126971) is an NIH Phase III randomized control trial (RCT) with intent to treat of caregivers (for allogeneic BMT patients) assigned to either treatment as usual or individualized stress management, psychoeducation, and relaxation training using a device for training paced respiration that also tracks compliance. Dependent measures include caregiver health, immune and endocrine markers, activity and sleep characteristics via actimetry, and stress assessment (perceived stress and caregiver burden) and mood (depression/anxiety) as well as patient medical outcomes. One immunological process has gained considerable attention in studies of chronic stress - inflammation. The present competing revision proposes an additional aim directed at malleability of inflammatory responses and glucocorticoid sensitivity as well as preliminary information regarding glucocorticoid receptor polymorphisms of the caregivers experiencing the intervention. Measures of ex vivo inflammation were not a focus in the parent project but complement the parent project nicely. Without altering this RCT, we will add inflammatory markers to the blood panel currently collected. Our working hypotheses for this new exploratory aim are that the invention compared to treatment as usual will 1) reduce inflammatory marker in plasma and whole blood responses to ex vivo stimulation and 2) increase glucocorticoid sensitivity to suppression by dexamethasone. For gathering preliminary information only, we will examine frequencies of three glucocorticoid receptor alleles related to stress reactivity. These observations have implications for identifying foundations of physiological resilience in this population. It fits an overarching goal of developing efficacious interventions for both patients and partners/families that support improved behavioral and medical health in cancer survivorship. This project has important public health implications. PUBLIC HEALTH RELEVANCE: In a nation where three out of every four American families will have at least one member diagnosed with cancer, "survivorship," according to the National Cancer Institute, includes both the patient and those who support them. Caregivers of blood and bone marrow transplant (BMT) recipients are a particularly distressed group since their care is required 24/7 for at least the first 100 days following transplantation. The present study adds a new aim to an ongoing randomized control trial of an intervention that includes stress management, psychoeducation, and relaxation training (CA126971). The new aim will focus on inflammatory processes that contribute to poor health in the caregiver and are significant because caregiver health is crucial to the long term prognosis of the patients.