Psychological and Immunological Reactions of Family Members to Patients Undergoing Bone Marrow Transplantation

Department of Psychiatry, University of Colorado Cancer Center, Denver, USA.
Psychosomatic Medicine (Impact Factor: 3.47). 11/1991; 58(5):472-80. DOI: 10.1016/0163-8343(91)90078-B
Source: PubMed

ABSTRACT The authors' goal was to evaluate the impacts of patients' bone marrow transplant (BMT) on their spouse/partner's (subjects) psychological and immunological status at four key points in the course of their transplant. Subjects' (N = 24) psychological and immunological status was prospectively evaluated at four key points in the patient's BMT which included: at patients' admission to hospital and 0-, 20-, and 34-day intervals after BMT infusion. Psychological variables examined included: a) general psychological distress and negative affect; b) tendency to respond in a socially desirable manner; c) state negative affect; and d) coping style, specifically if escape-avoidance coping was used. Immune variables examined included: percentages of total T cells and of CD4+, CD8+ cells, B cells, and natural killer (NK) cells, and NK cytotoxicity. Greatest abnormality in immune variables was detected before the initiation of BMT (i.e., between admission and day 0) with normalization between days 21 and 34 thereafter. During the waiting period before BMT, the subjects had the highest scores on negative affects, escape-avoidance coping, and psychological symptoms. These progressively declined after the BMT procedure. Significant correlations were found among trait anxiety, escape-avoidance coping, and total percentage of T cells and of CD4+ cells. Escape-avoidance coping was reliably correlated with percentage of B cells. The greatest psychological and immunological impacts on spouse/partners of BMT patients were found in the period directly after hospital admission and before BMT infusion. Alterations in immune values occurred in anticipation of BMT in the spouse/partners. Psychological symptoms followed this same pattern, being most elevated before BMT and decreasing in the successive evaluations post-BMT for the spouse/partners. The most significant and consistent psychological variable in predicting immune changes was escape-avoidance coping, with less escape-avoidance coping predicting better immune functioning.

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Available from: Ann Futterman Collier, Apr 11, 2014
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    • "The level of depression is much lower than that detected in a study done by Nelson et al. which showed 66% of mothers experienced depression pre-BMT (Nelson et al. 1997). Futterman et al. conducted a study of BMT patients and spouses to evaluate mechanisms of psychological distress and noted that patients and spouses experienced greatest negative and psychological stress during the period prior to admission for BMT (Futterman et al. 1996). The body of literature on psychosocial issues prior to BMT suggests a high level of stress in this acute time-period, but little is known about the long term effects of stress, anxiety and depression associated with illness uncertainty and anticipation of BMT over long periods of time. "
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    ABSTRACT: Fanconi Anemia (FA) is a rare genetic disease that generally affects children and results in bone marrow failure requiring blood or marrow transplantation for survival. A unique feature of the condition is the long, often many years, waiting period between genetic diagnosis and treatment. This qualitative study looked at the lived experience of parents confronting their child's diagnosis of FA. We aimed to describe factors which parents found helpful or detrimental during the waiting time period and to recommend strategies to support families who will have these experiences in the future. Categories that emerged were: parents' emotional responses, thoughts about FA (which occurred daily for most parents), sources of stress, mechanisms of coping, family dynamics and responses that were supportive and non-supportive. We found that most parents experience stress, uncertainty, and active surveillance throughout the course of the illness. Healthcare professionals, and especially physicians, were agents of both the most and least supportive experiences of parents. Parents described family centered team care as helpful throughout the illness and health professional education as a priority need.
    Journal of Genetic Counseling 07/2011; 21(1):45-58. DOI:10.1007/s10897-011-9394-5 · 2.24 Impact Factor
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    • "Appraisals of events as stressful, and the resulting emotional distress, contribute to a series of central nervous system and endocrine changes that can impact immunity. There are only limited immune data from spouses of cancer patients, but the available studies suggest compromised cellular immunity (Futterman et al., 1996), poorer inflammatory control (2009), and, in the only study examining immunocompetence among spouses of cancer patients with recurrence, suppressed response to skin test antigens (Mortimer et al., 2005). "
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    ABSTRACT: Spouses of cancer patients are at-risk for poor psychological and physical health as they cope with the complex nature of the disease and fears of losing their partner. Moreover, spouses often serve as patients' primary informal caregivers, a group that evidences poor outcomes across a variety of domains. The present study examines the relative contributions of cancer recurrence - a cancer-specific stressful event - and the subjective experience of cancer-specific stress (IES) in a sample of male spouses of breast cancer survivors. We hypothesized that stress would contribute to poorer physical health and compromised immune function. Spouses (recurrence; n=16) of patients who were coping with their first recurrence were matched to spouses of patients with no evidence of disease (disease-free; n=16). Self-reported physical health (physical symptoms and fatigue) and immune function [T-cell blastogenic response to the mitogens Concanavalin A (ConA) and phytohemagglutanin (PHA) and T3 monoclonal antibody (T3 Mab)] were included as outcomes. Results indicated that patient recurrence status was not a significant unique predictor of physical health or immune function; rather, among all spouses, cancer-specific stress symptoms were associated with increased physical symptoms and altered T-cell blastogenesis. These data suggest that the health implications of caregiving for spouses of cancer survivors is more strongly linked to their subjective experience of cancer as stressful, rather than simply the patients' disease status.
    Brain Behavior and Immunity 07/2011; 26(2):228-33. DOI:10.1016/j.bbi.2011.07.237 · 5.89 Impact Factor
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    • "This may induce regression, withdrawal, depression, and physical discomfort) such as abdominal pain and vomiting as well as the expression of violent anger and extreme dependence, leading to resistance or rejection of treatments such as oral medication and necessary procedures, and the medical staff may have difficulty in coping with these reactions (Kellerman et al., 1979; Günter et al., 1999) Moreover, sufficient mental care of not only the patient but also the family is indispensable for successful transplantation (Futterman et al., 1996), and active involvement of a psychiatrist is important (Kiss et al., 1994). "
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    ABSTRACT: Psychological symptoms are often seen in pediatric patients who are confined to a germ-free unit while undergoing bone marrow transplants. The Picture-Frustration Study( P-F study) was performed at the outpatient clinic before admission to the germ-free unit. After admission to the germ-free unit, the patients were interviewed once a week in the germ-free unit, and their mental symptoms were recorded in their clinical records. Condition of anxiety, unresponsiveness, resistance to treatment, and aggression have been noted in pediatric patients below the age of 18 in the Tokai University Hospital. Insomnia, appetite loss, anxiety, unresponsiveness showed a significant correlation with the patient's age. Forty-seven children were given the P-F study before entering the germ free unit. Anxiety, depression, and unresponsiveness correlated significantly with several items in the P-F study. The results of P-F study are useful in predicting the appearance of psychological or physical symptoms of patients confined to the germ-free unit.
    The Tokai journal of experimental and clinical medicine 01/2007; 32(1):30-3.
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