Benzodiazepine and zolpidem prescriptions during autologous stem cell transplantation

Banerjee, Rahul; Lazar, Ann; Dunn, Lisa; Knoche, Jennifer; Lo, Mimi; Arora, Shagun; Wong, Sandy W.; Wolf, Jeffrey L.; Martin, Thomas G.; Dhruva, Anand; Shah, Nina

doi:10.1002/jha2.148

Cited by 3 publications

(1 citation statement)

References 15 publications

(18 reference statements)

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“…Previous studies, while limited by substantial heterogeneity in patient populations and survey-based inventories, suggest that well-being reaches its nadir 1-2 weeks after SCT before recovering in subsequent months [5,[11][12][13][14][15][16]. Even so, long-term consequences of these short-term exacerbations may include persistent decreases in QOL, lowered posttransplant medication adherence, psychological comorbidities, reliance on potentially inappropriate medications such as benzodiazepines, and increased risk of hospital readmissions [17][18][19][20][21][22][23]. Several hospital-based interventions have thus been studied to target well-being during SCT, such as scheduled palliative care consultations, structured exercise programs, acupuncture, music therapy, and programmed room lighting [24][25][26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Digital Life Coaching During Stem Cell Transplantation: Development and Usability Study (Preprint)

Banerjee¹,

Huang²,

Dunn³

et al. 2021

Preprint

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BACKGROUND For patients with multiple myeloma receiving high-dose chemotherapy followed by autologous stem cell transplantation (SCT), acute life disruptions and symptom burden may lead to worsened quality of life (QOL) and increased emotional distress. Digital life coaching (DLC), whereby trained coaches deliver personalized well-being–related support via phone calls and SMS text messaging, has been shown to improve QOL among SCT survivors. However, DLC has not been investigated during the acute peri-SCT period, which is generally characterized by symptomatic exacerbations and 2-week hospitalizations. OBJECTIVE We launched a single-arm pilot study to investigate the feasibility of patient engagement with DLC during this intensive period. METHODS We approached English-speaking adult patients with multiple myeloma undergoing autologous SCT at our center. Enrolled patients received 16 weeks of virtual access to a life coach beginning on day −5 before SCT. Coaches used structured frameworks to help patients identify and overcome personal barriers to well-being. Patients chose the coaching topics and preferred communication styles. Our primary endpoint was ongoing DLC engagement, defined as bidirectional conversations occurring at least once every 4 weeks during the study period. Secondary endpoints were electronic patient-reported outcome assessments of QOL, distress, and sleep disturbances. RESULTS Of the 20 patients who were screened, 17 (85%) chose to enroll and 15 (75%) underwent SCT as planned. Of these 15 patients (median age 65 years, range 50-81 years), 11 (73%) demonstrated ongoing DLC engagement. The median frequency of bidirectional conversations during the 3-month study period was once every 6.2 days (range 3.9-28 days). During index hospitalizations with median lengths of stay of 16 days (range 14-31 days), the median frequency of conversations was once every 5.3 days (range 2.7-15 days). Electronic patient-reported outcome assessments (94% adherence) demonstrated an expected QOL nadir during the second week after SCT. The prevalence of elevated distress was highest immediately before and after SCT, with 69% of patients exhibiting elevated distress on day −5 and on day +2. CONCLUSIONS DLC may be feasible for older patients during intensive hospital-based cancer treatments such as autologous SCT for multiple myeloma. The limitations of our study include small sample size, selection bias among enrolled patients, and heterogeneity in DLC use. Based on the positive results of this pilot study, a larger phase 2 randomized study of DLC during SCT is underway to investigate the efficacy of DLC with regard to patient well-being. CLINICALTRIAL ClinicalTrials.gov NCT04432818; https://clinicaltrials.gov/ct2/show/NCT04432818.

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Section: Introductionmentioning

confidence: 99%

Digital Life Coaching During Stem Cell Transplantation: Development and Usability Study (Preprint)

Banerjee¹,

Huang²,

Dunn³

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

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Randomized phase 2 study of digital life coaching during transplantation for myeloma

Banerjee,

Huang,

Ryan

et al. 2023

Bone Marrow Transplant

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Digital Life Coaching During Stem Cell Transplantation: Development and Usability Study

Banerjee¹,

Huang²,

Dunn³

et al. 2022

JMIR Form Res

Self Cite

View full text Add to dashboard Cite

Background For patients with multiple myeloma receiving high-dose chemotherapy followed by autologous stem cell transplantation (SCT), acute life disruptions and symptom burden may lead to worsened quality of life (QOL) and increased emotional distress. Digital life coaching (DLC), whereby trained coaches deliver personalized well-being–related support via phone calls and SMS text messaging, has been shown to improve QOL among SCT survivors. However, DLC has not been investigated during the acute peri-SCT period, which is generally characterized by symptomatic exacerbations and 2-week hospitalizations. Objective We launched a single-arm pilot study to investigate the feasibility of patient engagement with DLC during this intensive period. Methods We approached English-speaking adult patients with multiple myeloma undergoing autologous SCT at our center. Enrolled patients received 16 weeks of virtual access to a life coach beginning on day −5 before SCT. Coaches used structured frameworks to help patients identify and overcome personal barriers to well-being. Patients chose the coaching topics and preferred communication styles. Our primary endpoint was ongoing DLC engagement, defined as bidirectional conversations occurring at least once every 4 weeks during the study period. Secondary endpoints were electronic patient-reported outcome assessments of QOL, distress, and sleep disturbances. Results Of the 20 patients who were screened, 17 (85%) chose to enroll and 15 (75%) underwent SCT as planned. Of these 15 patients (median age 65 years, range 50-81 years), 11 (73%) demonstrated ongoing DLC engagement. The median frequency of bidirectional conversations during the 3-month study period was once every 6.2 days (range 3.9-28 days). During index hospitalizations with median lengths of stay of 16 days (range 14-31 days), the median frequency of conversations was once every 5.3 days (range 2.7-15 days). Electronic patient-reported outcome assessments (94% adherence) demonstrated an expected QOL nadir during the second week after SCT. The prevalence of elevated distress was highest immediately before and after SCT, with 69% of patients exhibiting elevated distress on day −5 and on day +2. Conclusions DLC may be feasible for older patients during intensive hospital-based cancer treatments such as autologous SCT for multiple myeloma. The limitations of our study include small sample size, selection bias among enrolled patients, and heterogeneity in DLC use. Based on the positive results of this pilot study, a larger phase 2 randomized study of DLC during SCT is underway to investigate the efficacy of DLC with regard to patient well-being. Trial Registration ClinicalTrials.gov NCT04432818; https://clinicaltrials.gov/ct2/show/NCT04432818.

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Benzodiazepine and zolpidem prescriptions during autologous stem cell transplantation

Abstract: Multiple myeloma patients undergoing autologous stem cell transplantation (ASCT) may receive benzodiazepine or zolpidem-class (B/Z) medications despite their risks in older patients. Of 205 myeloma patients (36% aged 65+

Cited by 3 publications

References 15 publications

Digital Life Coaching During Stem Cell Transplantation: Development and Usability Study (Preprint)

Digital Life Coaching During Stem Cell Transplantation: Development and Usability Study (Preprint)

Randomized phase 2 study of digital life coaching during transplantation for myeloma

Digital Life Coaching During Stem Cell Transplantation: Development and Usability Study

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