Exercise and Stress Management Training Prior to Hematopoietic Cell Transplantation: Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 0902

Abstract

Studies show that engaging patients in exercise and/or stress management techniques during hematopoietic cell transplantation (HCT) improves quality of life. The Blood and Marrow Transplant Clinical Trials Network tested the efficacy of training patients to engage in self-directed exercise and stress management during their HCTs. The study randomized 711 patients at 21 centers to receive one of four training interventions before HCT: a self-directed exercise program, a self-administered stress management program, both or neither. Participants completed self-reported assessments at enrollment and up to 180 days after transplant. Randomization was stratified by center and transplant type. There were no differences in the primary endpoints of the physical (PCS) and mental (MCS) component scales of the SF36 at day 100 among the groups based on an intention-to-treat analysis. There were no differences observed in overall survival, hospital days through day 100 post-HCT, or in other patient-reported outcomes, including treatment-related distress, sleep quality, pain, and nausea. Patient randomized to training in stress management reported more use of those techniques; patients randomized to training in exercise did not report more physical activity. Although other studies have reported efficacy of more intensive interventions, brief training in an easy-to-disseminate format for either self-directed exercise or stress management was not effective in our trial.

How could patient reported outcomes improve patient management in chronic myeloid leukemia?

“…The use of the specific Medical Outcomes Study Short Form 36 questionnaire [38] prior to in 336 patients predicts overall mortality after transplant independently and as well as other commonly used non-PRO indexes [39]. In the same study, a reduction in the score early after HSCT was associated with an increased overall mortality and treatment-related mortality.…”

Engaging Patients in Setting a Patient-Centered Outcomes Research Agenda in Hematopoietic Cell Transplantation

“…While fatigue is a common concern across the transplant trajectory, little is known about how HCT patients and providers think about or discuss fatigue and physical health in clinical practice. In the HCT research setting, interventions to improve fatigue and physical health impairments largely have been small-scale efforts [26–28]. …”

Changing the Way We Approach Rehabilitation in Bone Marrow Transplantation

“…Interventions should aim to improve physical activity behaviours prior to treatment, so that patients are self-empowered to improve their own health and reduce the risk of negative secondary effects following alloBMT. Based on available evidence to date, it appears these patients benefit more from demonstrated or supervised exercise rather than self-directed programs [15]. Perhaps the best way to achieve behavioural change is to apply novel exercise approaches such as technology (activity devices, smart phone apps, telehealth) focused around education, training and enablement from the behavioural change wheel framework to implement exercise as part of routine life in people being prepared for and treated with alloBMT [16].…”