Psychoeducation for BMT caregivers: Biobehavioral markers and outcome

描述（由申请人提供）：照顾是一种生活挑战，具有许多心理和生理后果，导致发病率和死亡率增加。制定干预措施以照顾照顾者至关重要。根据美国国家癌症研究所（NCI） 2006年的数据，美国有超过1100万癌症幸存者。NCI认识到“……家庭成员、朋友和照顾者也是幸存者经历的一部分……”接受同种异体血液或骨髓移植（BMT）治疗免疫、血液和其他疾病的患者的护理人员面临着明显的压力体验。同种异体BMT的批准需要24小时/天的护理人员在场至少100天，通常更长。护理人员是病人康复过程中不可或缺的一部分。虽然护理人员可以减少与患者护理相关的医疗费用，但对护理人员的影响是实质性的，导致失去工作，经济负担，并增加了护理人员的医疗和心理健康问题。虽然许多社会心理干预针对癌症患者，但只有少数针对癌症护理人员，甚至更少跟踪与这些干预相关的健康生物标志物。家长研究（CA126971）是一项NIH III期随机对照试验（RCT），目的是治疗照顾者（异基因BMT患者），他们被分配到常规治疗或个性化的压力管理、心理教育和放松训练，使用一种训练有节奏呼吸的设备，并跟踪依从性。依赖指标包括护理者的健康状况、免疫和内分泌指标、通过活动测量的活动和睡眠特征、压力评估（感知压力和护理者负担）、情绪（抑郁/焦虑）以及患者的医疗结果。在慢性应激性炎症的研究中，一个免疫过程引起了相当大的关注。目前的竞争性修订提出了一个额外的目标，针对炎症反应的延展性和糖皮质激素敏感性，以及关于糖皮质激素受体多态性的初步信息的护理者经历干预。体外炎症的测量不是母项目的重点，但可以很好地补充母项目。在不改变该随机对照试验的情况下，我们将在目前收集的血液面板中添加炎症标记物。我们对这一新的探索性目标的工作假设是，与常规治疗相比，该发明将1)减少血浆和全血中炎症标志物对体外刺激的反应，2)增加糖皮质激素对地塞米松抑制的敏感性。为了收集初步信息，我们将检查与应激反应性相关的三种糖皮质激素受体等位基因的频率。这些观察结果对确定这一人群生理弹性的基础具有重要意义。它符合为患者和合作伙伴/家庭制定有效干预措施的总体目标，以支持改善癌症幸存者的行为和医疗健康。该项目具有重要的公共卫生影响。

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.