Contributions
Abstract: PB2382
Type: Publication Only
Background
Patients with myeloproliferative neoplasms experience significant symptom burden, including fatigue, pruritus and pain. The high symptom burden has been shown to be associated with decreased quality of life, sleep difficulties and mood disturbances. Acceptance and Commitment Therapy (ACT) is an evidence based psychological intervention targeting emotions, thoughts and behavior. ACT employs 6 core psychological processes to attain psychological flexibility: acceptance, flexible attention to the present moment, values clarification, committed action, self as context and defusion. Several Randomized Clinical Trials have reported the efficacy of ACT targeting mood, pain, and medical conditions such as Diabetes Mellitus, but it has never been investigated in patients with MPN. We launched a feasibility study to the ACT intervention among MPN patients to assess the ability to improve symptom burden, physical function and mitigate decreased QOL.
Aims
To evaluate the impact of Acceptance and Commitment Therapy in MPN patients.
Methods
10 participant intervention includes 6 one-hour, in person therapy sessions with an ACT-certified psychologist. Assessments are based on validated questionnaires to assess MPN specific symptoms, global health, perceived stress, fatigue and degree of acceptance.
Results
We enrolled 5 MPN patients to date, the 4 patients who completed the pre and post surveys were evaluable for review. Most of the patients (N=3) were female and with an average age of 63.5 years. Two were actively working outside of the home and two were retired. One patient’s MPN diagnosis came 1-3 years ago, the remaining 3 patients were diagnosed more than 5 years ago. Most of the patients endorsed constitutional symptoms (N=3), with fatigue being the most bothersome (N=3). At baseline, at least half of participants (≥2) reported feeling not able to control worrying, lack of interest or pleasure in activities, feeling depressed or hopeless, feeling bad about themselves, trouble concentrating several days a week, feeling nervous, worrying “too much”, trouble relaxing, irritability, trouble falling asleep, and feeling tired several days a week. After the intervention, there was a decrease in degree of fatigue experienced at the time of documentation (median change (MC) -2.0) and over the past 24 hours (MC -1.5). In the post-intervention setting, there was a decrease in frequency of participant reported negative experiences including distress, negative emotions, difficulty with handling situations. Additionally, there was an improvement in patient reported assessment of quality of life, mental health and satisfaction with social roles and activities.
Conclusion
Patients with MPNs have a high degree of physical stress from their disease, psychological distress from the impact of their disease on their ability to function within their social network, and emotional stress of having a hematologic malignancy. ACT may be a feasible option to improve patient experience with predominantly incurable myeloproliferative neoplasm. In addition to developing disease modifying pharmaceutical interventions, the health care system must also develop innovative methods of addressing symptoms and the psychological distress of a hematologic malignancy.
Session topic: 36. Quality of life, palliative care, ethics and health economics
Abstract: PB2382
Type: Publication Only
Background
Patients with myeloproliferative neoplasms experience significant symptom burden, including fatigue, pruritus and pain. The high symptom burden has been shown to be associated with decreased quality of life, sleep difficulties and mood disturbances. Acceptance and Commitment Therapy (ACT) is an evidence based psychological intervention targeting emotions, thoughts and behavior. ACT employs 6 core psychological processes to attain psychological flexibility: acceptance, flexible attention to the present moment, values clarification, committed action, self as context and defusion. Several Randomized Clinical Trials have reported the efficacy of ACT targeting mood, pain, and medical conditions such as Diabetes Mellitus, but it has never been investigated in patients with MPN. We launched a feasibility study to the ACT intervention among MPN patients to assess the ability to improve symptom burden, physical function and mitigate decreased QOL.
Aims
To evaluate the impact of Acceptance and Commitment Therapy in MPN patients.
Methods
10 participant intervention includes 6 one-hour, in person therapy sessions with an ACT-certified psychologist. Assessments are based on validated questionnaires to assess MPN specific symptoms, global health, perceived stress, fatigue and degree of acceptance.
Results
We enrolled 5 MPN patients to date, the 4 patients who completed the pre and post surveys were evaluable for review. Most of the patients (N=3) were female and with an average age of 63.5 years. Two were actively working outside of the home and two were retired. One patient’s MPN diagnosis came 1-3 years ago, the remaining 3 patients were diagnosed more than 5 years ago. Most of the patients endorsed constitutional symptoms (N=3), with fatigue being the most bothersome (N=3). At baseline, at least half of participants (≥2) reported feeling not able to control worrying, lack of interest or pleasure in activities, feeling depressed or hopeless, feeling bad about themselves, trouble concentrating several days a week, feeling nervous, worrying “too much”, trouble relaxing, irritability, trouble falling asleep, and feeling tired several days a week. After the intervention, there was a decrease in degree of fatigue experienced at the time of documentation (median change (MC) -2.0) and over the past 24 hours (MC -1.5). In the post-intervention setting, there was a decrease in frequency of participant reported negative experiences including distress, negative emotions, difficulty with handling situations. Additionally, there was an improvement in patient reported assessment of quality of life, mental health and satisfaction with social roles and activities.
Conclusion
Patients with MPNs have a high degree of physical stress from their disease, psychological distress from the impact of their disease on their ability to function within their social network, and emotional stress of having a hematologic malignancy. ACT may be a feasible option to improve patient experience with predominantly incurable myeloproliferative neoplasm. In addition to developing disease modifying pharmaceutical interventions, the health care system must also develop innovative methods of addressing symptoms and the psychological distress of a hematologic malignancy.
Session topic: 36. Quality of life, palliative care, ethics and health economics