The Positive Effect of Inpatient Care-Partners During Allogeneic Bone Marrow Transplantation; A Prospective Trial
Authors: McLellan Linda , Foster Larry , Rybicki Lisa , Dabney Jane , Cooper Michele , Duong Hien , Sobecks Ronald , Kalaycio Matt , Copelan Edward A. , Dean Robert , Pohlman Brad , Andresen Steven , Tench Shawnda , Bolwell Brian J. 
Published: October 2019

Abstract 931

We have previously reported a retrospective study describing the positive impact on survival of allogeneic bone marrow transplant (BMT) recipients having a consistent care-partner during their inpatient hospitalization. To validate these observations, in 2003 we launched a prospective trial comparing the clinical and psychosocial outcomes of ablative allogeneic BMT patients with inpatient care-partners to those who did not have a care-partner.

Every ablative allogeneic BMT patient transplanted from 10/03 – 11/08 was asked to enroll on this study and 164 of 213 enrolled. Reasons for not participating were medical illness severity precluding completion of psychosocial form, language barriers, and care-partners unwilling to participate. As part of the study, BMT social workers completed a Psychosocial Assessment of Candidates for Transplantation (PACT) scale, and patients completed three psychometric instruments: Brief COPE scale, Functional Assessment of Cancer Therapy – Bone Marrow Transplantation (FACT-BMT) scale, and Profile of Mood States – Short Form (POMS) at five time points (pre-admission to 12 months post transplant). For the purposes of this study, a consistent care-partner was defined as one person being on the inpatient BMT unit with the patient five or more days per week. The total study population was 164 patients, 88 with care-partners and 76 without. The most common diagnosis was AML, followed by ALL, MDS, and CML. There was no difference between groups with and without care-partners in primary diagnosis, time from diagnosis to transplant, related versus unrelated transplants, disease status, donor source, co-morbidity status or age (median age was 44 years old). At baseline, patients with a care-partner had better physical wellbeing on FACT-BMT (p=0.014) and better (lower) scores for substance use on Brief COPE (p=0.007), but worse scores for planning (p=0.049) then patients with no care-partner. There were no significant differences of mood state scores between the two groups at baseline. The median follow-up is 41.2 months (range 16.4 – 73.7). The amount of time the care-partner actually stayed with the patient was recorded on a weekly log. Sixty percent of care-partners were spouse and thirty percent were parents. Sixty-six percent were employed and fourteen percent were retired. Eighty-seven percent lived with the patient prior to admission. The care-partners were with the patients a median of 7.5 hours per day. As shown below, patients with a consistent care-partner had a statistically significant improvement in survival.

Twenty-nine percent of patients without care-partners are still alive versus forty-seven percent of those with care-partners. The survival curves diverge approximately six months post transplant. Forty-six percent of patients in the non care-partner group died of infections/pneumonia, or other organ failure versus twenty-five percent in the care-partner group. Univariable and multivariable analysis confirmed that the presence of a consistent care-partner favorably influenced survival.

In conclusion, we have verified our retrospective observation that the presence of a consistent care-partner improves survival. The mechanisms are unclear. The fact that the survival curves begin to diverge six months post transplant suggest that the benefit of a consistent care-partner during the hospitalization may translate into extended benefits post transplant. Alternatively, the care-partner relationship may be more important post-transplant and influence compliance or other variables. Our goal for future research is to attempt to define the benefit of the care-partner relationship and determine interventions for those without care-partners.

Disclosures:

No relevant conflicts of interest to declare.