Longitudinal associations between patient and caregiver quality of life following hematopoietic stem cell transplantation.

Caregivers of patients undergoing hematopoietic stem cell transplantation (HSCT) experience high rates of psychological distress, yet patient-level factors most strongly associated with caregiver outcomes over time remain poorly understood. We evaluated longitudinal associations between patient and caregiver quality of life (QoL) following HSCT. We conducted a secondary analysis of the PROTECT randomized trial of integrated palliative care during HSCT. Among enrolled patient-caregiver dyads, we measured patient (FACT-BMT) and caregiver (CarGOQoL) QoL at baseline, week 2, and months 3, 6, and 12. Only patient-caregiver dyads that completed both measures were included in analyses at each timepoint. Linear mixed-effects models were used to assess the relationship between changes in patient QoL and changes in caregiver QoL, adjusting for time and treatment arm. Among 186 enrolled patient-caregiver dyads, patients had a mean age of 55.2 ± 12.4 years and 65% were male. Mean CarGOQoL remained stable from baseline through month 12 (range: 74.1–75.9). FACT-BMT declined at week 2 (91.9 ± 20.4) compared to baseline (105.0 ± 18.8), then recovered and improved by month 3 through month 12 (Table 1). In multivariable mixed-effects modeling, within dyads, visits where the patient’s QoL exceeded their usual level were associated with higher caregiver QoL (β = 0.11 per 1-point above the patient’s mean; p < 0.001), adjusted for time and arm. While average caregiver QoL remained stable throughout the follow-up period despite changes in average patient QoL, individual caregiver QoL closely tracked their patient's QoL over the post-HSCT follow-up period. Patient-reported QoL represents a clinically meaningful marker to identify at-risk caregivers. Interventions targeting patient QoL may yield dual benefits for patient-caregiver dyads. .

Duke Scholars

Author Thomas William LeBlanc Medicine, Hematologic Malignancies and Cellular Therapy

Author Jesse David Troy Biostatistics & Bioinformatics, Division of Biostatistics