Psychosocial Issues In
Bone Marrrow Transplant
Jennifer Blosser, LCSW, ACSW, CSWHC & Susan Striano, MSW
November 2011
Objectives
 Identify Biopsychosocial and Spiritual
issues in BMT
 Understand patient and caregiver issues
 Identify resources and strategies to assist
 Identify components of a patient
evaluation that elicits important factors
predictive of coping
(2011) Blosser, Jennifer
Bio-psychosocial?
 The biological, psychological and
social affect a person’s response to
illness and treatment
 The mind and body connection
 Health care staff need to address the
person holistically
 Contrasts with a reductionist model
of disease
(2011) Blosser, Jennifer
Constellation




Family
Work
Health
Spirituality
 Genetics
 Life Experience
 Resilience
 Temperment
(2011) Blosser, Jennifer
Who Cares?





BMT is extremely rigorous
Long recovery times
Side effects
Late effects/Survivorship
High risks of mortality
(2011) Blosser, Jennifer
Practical Matters




Patient and caregiver may relocate
Need plans for home and family
May be out of work
Resources stretched thin
 Patient pay amounts
 Gas mileage
 Dreaded doughnut hole
(2011) Blosser, Jennifer
Spiritual






Chronic sorrow (Olshansky, 1962)
Role loss
Facing mortality
Wearing out the system
Sin and Salvation
Search for meaning
(2011) Blosser, Jennifer
Mental/Emotional











Anxiety and Depression
Denial/Minimization
Anger
Fears of the unknown
Loss of control
Dependence
Deterioration
Side effects/Pain/Suffering
Reaction of others
Fear of relapse
ENGULFMENT
(2011) Blosser, Jennifer
Physical






Fatigue/sleep disturbance
Sexual dysfunction
Side effects of medicine
Side effects of GVHD
Where is my wellness
Cognitive changes
(2011) Blosser, Jennifer
Young Adults
 Ill at transitional time in
development
 Tasks of individuation interrupted
 Negotiating friendships and intimate
relationships
 Moving back home
 Some treated first when children
(2011) Blosser, Jennifer
Continuum of Coping
 Emotional acceptance . . . Cognitive
awareness . . . Adherence to
treatment
 What led them to decision
 What have they read/heard about
process (did they read materials)
 Glass half full or half empty?
(2011) Blosser, Jennifer
Risks






Decreased adherence
Failure to thrive
Increased somatization
Question quality of life
Failure of expectations for recovery
Need to adjust to new baseline
(2011) Blosser, Jennifer
Caregivers
Have different experience
Extra duties/roles
Finances/job pressures for time off
Anticipatory grief
Loss of self care
Bringing baggage with you (pt., too)
Overwhelmed by systems (pt.,
too)(medical/insurance)
 Resources dedicated to patients
 Distress higher than patients







(2011) Blosser, Jennifer
Special Situations
 Gay, lesbian and transgender
partners as caregivers
 Homosexual persons with cancer
 Caregivers with disabilities
 Language and multicultural
differences from treatment staff
(2011) Blosser, Jennifer
Survivorship
 BMTInfoNet survey 2007




Emotional/Psychiatric
Late Effects
Fatigue
Worry about family/caregivers
(2011) Blosser, Jennifer
COOL!
 Psychosocial support and emotional
issues can be predictive of well-being
following transplant (Hoodin, et al,
2006)
 Hypothesis: emotional adjustment
and psychosocial support can be
immune modulatory
(2011) Blosser, Jennifer
Case Example
 Medical
 History of illness experience
 Past medical history
 Home and family
 Environmental issues
 Pets
 Health of family
(2011) Blosser, Jennifer
Financial
 Education/Employment
 Status of finances
 Insurance ok?




Copays
Deductables
Out of pocket maxes
Medicines
(2011) Blosser, Jennifer
Substances/Mental
Health/Legal
 History of substance use
 Patient
 Family
 Potential caregivers
 Mental health history
 Legal issues
 Court hearings, financial, incarcerations,
wills/advanced directives/POAs
(2011) Blosser, Jennifer
Learning and Education





Patient and family learning style
What have they received
Did it meet their needs
Was is understood
History of learning problems or
literacy issues
(2011) Blosser, Jennifer
Adjustment
 General impressions of mood and
coping for patient and family
 Relevant history
 History with medical situations
 Specific phobias
 Coping with staff, long waits, when
things go wrong
 Conclusions/Needs
(2011) Blosser, Jennifer
How to Cope








Exercise (Wiskman&Huber, 2008)
Education
Nutrition
Medicine
Counseling
Get a role!
Clergy
Family/community
(2011) Blosser, Jennifer
 Integrative approaches







Yoga
Visualization/guided imagery
Prayer/Meditation
Journaling
Celebrate landmarks (Stronach, 2002)
Acknowledge loss, consider gains
Value in being vs. doing
(2011) Blosser, Jennifer
Community Resources








Organizations related to patient diagnosis
Grants/fundraising
Social Security
Medicaid/Medicare
Grief/bereavement support
Support groups
Churches
Family/friends/neighbors/other patientsfamilies
(2011) Blosser, Jennifer
Emotional Support
 American Psychosocial Oncology
Society 1 866 276 7443, apossociety.org
 Cancer Info and Counseling Line
1 800 525 3777
 bmtinfonet.org
 thewellnesscommunity.org
 cancercare.org 1 800 813 4673
(2011) Blosser, Jennifer
Fatigue
 National Comprehensive Cancer
Network www.nccn.org
 Oncology Nursing Society
www.ons.org/outcomes/volume1/fatig
ue.shtml
 American Cancer Society, National
Cancer Institute, Livestrong.org
 Your local cancer rehab program
(2011) Blosser, Jennifer
Cognitive





Meds
Behavioral interventions
Relaxation/stress management
Job retraining
Treatment of underlying medical
conditions
(2011) Blosser, Jennifer
Caregivers
 Family Caregiver Alliance www.caregiver.org
 National Family Caregivers Association
www.nfcacares.org
 Wellspouse Association www.wellspouse.org
 Caringbridge and Carepages
 Young Spouses www.youngcancerspouses.org
 www.strengthforcaring.com
 www.familycaregiving101.org
 www.sharethecare.org
(2011) Blosser, Jennifer
Young Adults
www.Planetcancer.org
www.stupidcancer.com
www.CampDream.org
www.Fertilehope.org
www.preparetolive.org
www.pregnantwithcancer.org
www.vitaloptions.org
www.cancer.gov/cancertopics/aya/resourc
es
 www.cancercare.org








(2011) Blosser, Jennifer
Humor
 Laughter known to reduce blood
pressure, increase feel-good
neurochemicals and reduce
subjective feelings of depression.
 “I may not be totally perfect, but
parts of me are excellent,” (Ashleigh
Brilliant).
(2011) Blosser, Jennifer
(2011) Blosser, Jennifer
Bibliography
 Anderson, KO, Giralt, SA, Mendoza, TR, Brown, JO,
Neumann, JL, Mobley, GM, Wang, XS and Cleeland, CS.
Symptom burden in patients undergoing autologous stem
cell transplantation. Bone Marrow Transplantation
(2007) 39, 759-766.
 Andorsky, DJ, Loberiza Jr, FR and Lee, SJ. Pretransplantation physical and mental functioning is strongly
associated with self reported recovery from stem cell
transplantation. Bone Marrow Transplantation (2006) 37,
889-895.
 Beanlands, H, Lipton, J, McCay, E, Schimmer, A, Elliott,
M, Messner, H, et al. Self-concept as a “BMT Patient,”
illness intrusiveness, and engulfment in allogeneic bone
marrow transplant recipients. Journal of Psychsomatic
Research (2003) 55, 419-425.
(2011) Blosser, Jennifer
 Bishop,M. For Better and For Worse: Impact of Cancer
and BMT on Family-Caregivers. BMT Info Net
Survivorship Conference (2008) Dallas, TX.
 Bolte, S. The Unique Needs of Young Adult Survivors.
BMT Info Net Survivorship Conference, (2008) Dallas,
TX.
 Boswell, HB. Hormone Replacement After Cancer
Treatment. BMT Info Net Survivorship Conference
(2008) Dallas, TX.
 Carlton, T. (1984). Clinical Social Work in Health
Settings. New York: Springer Publishing Company.
 Fife, BL, Huster, GA, Cornetta, KG, Kennedy, VN, Akard,
LP, and Broun, ER. Longitudinal Study of Adaptation to
the Stress of Bone Marrow Transplantation. Journal of
Clinical Oncology (2000) 18 (7) 1539-1549.
(2011) Blosser, Jennifer
 Giralt, S. Protecting Your Health Long Term. BMT Info
Net Survivorship Conference (2008) Dallas, TX.
 Gielissen, MFM, Schattenberg, AVM, Verhagen,
CAHHVM, Rinkes, MJ, Bremmers, MEJ and Bleijenberg,
G. Experience of severe fatigue in long-term survivors of
stem cell transplantation. Bone Marrow Transplantation
(2007) 39, 595-603.
 Goetzmann, L, Klaghofer, R, Wagner-Huber, R, Halter, J,
Boehler, A, Muellhaupt, B, et al. Psychosocial vulnerability
predicts psychosocial outcome after an organ transplant:
Results of a prospective study with lung, liver and bone
marrow transplant patients. Journal of Psychosomatic
Research (2007) 62, 93-100.
 Grant, M, Ferrell, B, Schmidt, GM, Fonbuena, P, Niland,
JC, and Forman, SJ. Measurement of quality of life in bone
marrow transplantation survivors. Quality of Life
Research (1992) 1, 375-384.
(2011) Blosser, Jennifer
 Hochhausen, N, Altmaier, E, McQuellon,R, Davies, S,
Papdopolpous, E, Carter, S & Henslee-Downey,J. Social
Support, Optimism, and Self-Efficacy Predict Physical and
Emotional Well-Being After Bone Marrow
Transplantation. Journal of Psychosocial Oncology
(2007) 25(1) 87-101.
 Hoodin, F, Uberti JP, Lynch, TJ, Steele, P, and
Ratanatharathorn, V. Do negative or positive emotions
differentially impact mortality after adult stem cell
transplant? Bone Marrow Transplantation (2006) 38,
255-264.
 Humphreys, CT, Tallman, B, Altmaier, EM and Barnette,
V. Sexual functioning in patients undergoing bone marrow
transplantation: a longitudinal study. Bone Marrow
Transplantation (2007) 39, 491-496.
(2011) Blosser, Jennifer
 Jenks Kettman, J & Altmaier, E. Social support and
depression among bone marrow transplant patients.
Journal of Health Psychology (2008) 13(1) 39-46.
 Johnson Vicksburg, S, Duhamel, K, Smith, M, Manne, S,
Winkel, G, Papadoupoulous, E, et al. Global meaning and
psychological adjustment among survivors of bone marrow
transplant. Psycho-oncology (2001) 10, 29-39.
 Meyers, CA. Chemobrain: Is it Real? BMT Info Net
Survivorship Conference (2008) Dallas, TX.
 Morales, JL. Cancer and the Law – What You Need to
Know. BMT Info Net Survivorship Conference (2008)
Dallas, TX.
 Northen, H. (1982). Clinical Social Work. New York:
Columbia University Press.
(2011) Blosser, Jennifer
 Olshansky, S. Chronic Sorrow: A response to having a
mentally defective child, Social Casework (1962) 43, 190193.
 Pavletic, S. Chronic Graft-versus-Host Disease. BMT Info
Net Survivorship Conference (2008) Dallas, TX.
 Schover, L. Sexuality After Transplant: A Workshop for
Men. BMT Info Net Survivorship Conference (2008)
Dallas, TX.
 Steel, JL, Nadeau, K, Olek, M & Carr, BI. Preliminary
Results of an Individually Tailored Psychosocial
Intervention for Patients with Advanced Hepatobiliary
Carcinoma. Journal of Psychosocial Oncology (2007) 25
(3) 19-42.
(2011) Blosser, Jennifer
 Stronach, K. (2002). “Survivors Guide for Bone Marrow
and Stem Cell Transplant: What to Expect and How to Get
Through it.” 2nd Edition. nbmtLINK, Southfield, MI.
 Sullivan, AK, Szkrumelak, N & Hoffman, LH
Psychological risk factors and early complications after
bone marrow transplantation in adults. Bone Marrow
Transplantation (1999) 24, 1109-1120.
 Syrjala, K. Riding the Emotional Roller Coaster of
Survival. BMT Info Net Survivorship Conference (2008)
Dallas, TX.
 Syrjala, K. Female Sexuality After Transplant: A
Workshop for Women. BMT Info Net Survivorship
Conference (2008) Dallas, TX.
(2011) Blosser, Jennifer
 Washington, AW. (1999) Cross-cultural issues in
transplant compliance. Transplant Proceedings (1999)
31(4) sup. 1, 27s-28s.
 Wiskemann, J and Huber,G. Physical exercise as adjuvant
therapy for patients undergoing hematopoietic stem cell
transplantation. Bone Marrow Transplantation (2008)
41, 321-329
 jblosser@mcvh-vcu.edu for questions!
(2011) Blosser, Jennifer