A Positive Psychology Intervention in Allogeneic Hematopoietic Stem Cell Transplantation Survivors (PATH): A Pilot Randomized Clinical Trial

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Hermioni L. Amonoo Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, MA
Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
Harvard Medical School, Boston, MA

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Elizabeth Daskalakis Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA

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Emma D. Wolfe Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA

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Michelle Guo Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
Harvard Medical School, Boston, MA

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Christopher M. Celano Harvard Medical School, Boston, MA
Department of Psychiatry, Massachusetts General Hospital, Boston, MA

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Brian C. Healy Harvard Medical School, Boston, MA
Department of Neurology, Brigham and Women’s Hospital, Boston, MA

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Corey S. Cutler Harvard Medical School, Boston, MA
Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA

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Joseph H. Antin Harvard Medical School, Boston, MA
Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA

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William F. Pirl Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, MA
Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
Harvard Medical School, Boston, MA

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Elyse R. Park Harvard Medical School, Boston, MA
Department of Psychiatry, Massachusetts General Hospital, Boston, MA

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Heather S.L. Jim Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL

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Stephanie J. Lee Division of Medical Oncology, Fred Hutchinson Cancer Center, University of Washington, Seattle, WA

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Thomas W. LeBlanc Duke Cancer Institute, Durham, NC
Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC

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Areej El-Jawahri Harvard Medical School, Boston, MA
Mass General Cancer Center, Massachusetts General Hospital, Boston, MA

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Jeff C. Huffman Harvard Medical School, Boston, MA
Department of Psychiatry, Massachusetts General Hospital, Boston, MA

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Background: Allogeneic hematopoietic stem cell transplantation (HSCT) survivors experience significant psychological distress and low levels of positive psychological well-being, which can undermine patient-reported outcomes (PROs), such as quality of life (QoL). Hence, we conducted a pilot randomized clinical trial to assess the feasibility and preliminary efficacy of a telephone-delivered positive psychology intervention (Positive Affect for the Transplantation of Hematopoietic stem cells intervention [PATH]) for improving well-being in HSCT survivors. Methods: HSCT survivors who were 100 days post-HSCT for hematologic malignancy at an academic institution were randomly assigned to either PATH or usual care. PATH, delivered by a behavioral health expert, entailed 9 weekly phone sessions on gratitude, personal strengths, and meaning. We defined feasibility a priori as >60% of eligible participants enrolling in the study and >75% of PATH participants completing ≥6 of 9 sessions. At baseline and 9 and 18 weeks, patients self-reported gratitude, positive affect, life satisfaction, optimism, anxiety, depression, posttraumatic stress disorder (PTSD), QoL, physical function, and fatigue. We used repeated measures regression models and estimates of effect size (Cohen’s d) to explore the preliminary effects of PATH on outcomes. Results: We enrolled 68.6% (72/105) of eligible patients (mean age, 57 years; 50% female). Of those randomized to PATH, 91% completed all sessions and reported positive psychology exercises as easy to complete and subjectively useful. Compared with usual care, PATH participants reported greater improvements in gratitude (β = 1.38; d = 0.32), anxiety (β = −1.43; d = −0.40), and physical function (β = 2.15; d = 0.23) at 9 weeks and gratitude (β = 0.97; d = 0.22), positive affect (β = 2.02; d = 0.27), life satisfaction (β = 1.82; d = 0.24), optimism (β = 2.70; d = 0.49), anxiety (β = −1.62; d = −0.46), depression (β = −1.04; d = −0.33), PTSD (β = −2.50; d = −0.29), QoL (β = 7.70; d = 0.41), physical function (β = 5.21; d = 0.56), and fatigue (β = −2.54; d = −0.33) at 18 weeks. Conclusions: PATH is feasible, with promising signals for improving psychological well-being, QoL, physical function, and fatigue in HSCT survivors. Future multisite trials that investigate PATH’s efficacy are needed to establish its effects on PROs in this population.

Submitted October 11, 2023; final revision received November 28, 2023; accepted for publication November 28, 2023.

These authors are co–senior authors.

Author contributions: Conceptualization: Amonoo, El-Jawahri, Huffman. Data curation: Amonoo, Daskalakis, Wolfe. Formal analysis: Amonoo, Healy, El-Jawahri, Huffman. Funding acquisition: Amonoo, Huffman. Investigation: Daskalakis, Wolfe. Methodology: Amonoo, El-Jawahri, Huffman. Project administration: Amonoo. Supervision: Amonoo. Visualization: Amonoo. Writing—original draft: Amonoo. Writing—review & editing: All authors.

Disclosures: Dr. Jim has disclosed serving as a consultant for SBR Biosciences; and receiving grant/research support from Kite Pharma. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award number K08CA251654 (H.L. Amonoo), and the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number R01HL113272 (J.C. Huffman).

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2023.7117. The supplementary material has been supplied by the author(s) and appears in its originally submitted form. It has not been edited or vetted by JNCCN. All contents and opinions are solely those of the author. Any comments or questions related to the supplementary materials should be directed to the corresponding author.

Correspondence: Hermioni L. Amonoo, MD, MPP, MPH, 60 Fenwood Road, 4th Floor, Boston, MA 02115. Email: hermioni_amonoo@dfci.harvard.edu

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