This is a resubmission of a competing continuation application: R01 CA 63030. This proposal would test a behavioral and interdisciplinary triage team intervention for blood and marrow transplantation (BMT) survivors which is cost and resource conserving and can be made available to virtually any survivor. The proposed design is a randomized controlled clinical trial in a consortium, with national multi-site accrual (N= 386 accrued pretransplant; 230 surviving to one year follow-up). Family caregivers are accrued where identifiable. Based on our prior research, we have targeted the dominant areas of long-term concern for a majority of BMT survivors. The study prescribes intervention early, after patients return home to widely divergent community resources, and before problems develop into maladaptive patterns that sustain long-term impairments.
Specific aims are to determine whether the intervention package assists transplant recipients and their families in: 1) managing rehabilitation needs including reduced stamina and cognitive limitations; 2) adjusting to fluctuations in family roles and emotions; and 3) managing menopausal symptoms and sexual function changes (for women only). Male and female adult survivors, with a primary caregiver, will receive one of two interventions: I.) Standard Treatment consisting of usual discharge preparation at each BMT site prior to return home; or II.) An Intervention Package consisting of nine (for men) or ten (for women) psychoeducational telephone counseling sessions over the year after return home from transplant. Problems identified with the telephone counselor will be triaged for additional assessment and resource activation by a study nurse. Assessments include pre- and post-transplant baselines prior to randomization and intervention, with one and two year follow-up assessments to evaluate the intervention efficacy. Primary hypotheses include that survivors who participate in the intervention will have improved function in the targeted areas and that this improvement will be mediated through increased use of active coping strategies. This research builds directly on the work of the previous grant cycle by extending the prior specific aims to a wider group of patients through an improved methodology. The BMT setting provides a well-standardized environment in which to test interventions that will be applicable to both the ever-increasing numbers of transplantation survivors and other populations of cancer survivors.
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