Over one-third of adult survivors of bone marrow stem cell transplantation (BMT/SCT) in the treatment of cancer experience clinically significant psychological distress. Symptoms include: anxiety, depression, intrusive thoughts, and sleep disturbances. The goal of the proposed research is to improve long term adjustment in survivors of traditional and mini/light BMT/SCT.
Specific aims are to: 1) Test the efficacy of a ten-session cognitive-behavioral intervention (CBT-BMT/SCT) on cancer-specific anxiety, psychological distress, and quality of life concerns among BMT/SCT survivors; 2) Explore the influence of patient and medical factors on the impact of CBT-BMT/SCT; and 3) Investigate barriers to participation in CBTBMT/ SCT. Cancer survivors who received either traditional or mini/light BMT/SCT (one - two years prior) will be recruited from three sites (Memorial Sloan-Kettering, M.D. Anderson, and Mount Sinai) and will be randomly assigned to CBT-BMT/SCT or to a usual care control condition. Participants in both groups will be assessed before, during and after (1 week, 3 months and 6 months) the CBT-BMT/SCT group's intervention. CBT-BMT/SCT will include: 1) Education regarding problems associated with BMT/SCT survivorship, 2) Training in relaxation skills and systematic desensitization, 3) Coaching in cognitive coping skills, and 4) Facilitating enlistment of helpful social support . The impact of the intervention will be assessed using standardized measures of anxiety, distress and quality of life. Analyses will also be conducted to determine the contribution of six factors (sociodemographic variables, treatment expectancies, life events, social support/social constraints, global meaning and medical factors such as type of transplantation) to the impact of CBT-BMT/SCT. Barriers to participation in CBT-BMT/SCT (e.g., initial level of cancer specificanxiety and distress, and physician's recommendation) will also be investigated. Once the clinical utility of CBT-BMT/SCT is established, the manualized intervention can be disseminated to those responsible for the care of BMT/SCT survivors. The proposed study will be the first investigation of its kind with BMT/SCT survivors and directly addresses the NCI research priority areas outlined in NCI's 2001 Progress Review Group Report on Leukemia/Lymphoma/Myeloma.
