Biobehavioral Implications of Covid-19 for Transplantation and Cellular Therapy Recipients

A growing body of literature has emphasized the importance of biobehavioral processes – defined as the interaction of behavior, psychology, socioenvironmental factors, and biological processes – for clinical outcomes among transplantation and cellular therapy (TCT) patients. TCT recipients are especially vulnerable to distress associated with pandemic conditions and represent a notably immunocompromised group at greater risk for SARS-CoV-2 infection with substantially worse outcomes. The summation of both the immunologic and psychologic vulnerability of TCT patients renders them particularly susceptible to adverse biobehavioral sequelae associated with the Covid-19 pandemic. Stress and adverse psychosocial factors alter neural and endocrine pathways through sympathetic nervous system and hypothalamic-pituitary-adrenal axis signaling that ultimately affect gene regulation in immune cells. Reciprocally, global inflammation and immune dysregulation related to TCT contribute to dysregulation of neuroendocrine and central nervous system function, resulting in the symptom profile of depression, fatigue, sleep disturbance, and cognitive dysfunction. In this article, we draw upon literature on immunology, psychology, neuroscience, hematology and oncology, Covid-19 pathophysiology, and TCT processes to discuss how they may intersect to influence TCT outcomes, with the goal of providing an overview of the significance of biobehavioral factors in understanding the relationship between Covid-19 and TCT, now and for the future. We discuss the roles of depression, anxiety, fatigue, sleep, social isolation and loneliness, and neurocognitive impairment, as well as specific implications for sub-populations of interest, including pediatrics, caregivers, and TCT donors. Finally, we address protective psychological processes that may optimize biobehavioral outcomes affected by Covid-19.

Perceptions and Experiences of Hematopoietic Cell Transplantation Patients During the COVID-19 Pandemic.

OBJECTIVES: Since March 2020, the severe acute respiratory syndrome coronavirus-2 pandemic has affected the global community, but poses unique challenges for individuals with cancer. Patients diagnosed with hematologic malignancies undergo aggressive therapies followed by hematopoietic cell transplantation (HCT) as a potential curative treatment. HCT recipients can be immunocompromised for extended periods of time, and even pre-pandemic, transplant patients reported depression and anxiety due to restrictions and infection prevention measures they had to adhere to as part of transplant precautions. This study aimed to understand psychological distress and capture perspectives on coping strategies and access to healthcare in the HCT population during the COVID-19 pandemic. DATA SOURCES: Adult patients who received a transplant or were awaiting transplant and had a scheduled appointment at the transplant clinic were eligible to participate in this cross-sectional study. Participants completed an online survey that included questionnaires, clinical data and demographic information. CONCLUSION: Fifty-four participants completed the survey. HCT participants reported relatively high psychological distress during the initial phase of the COVID-19 pandemic, but indicated use of healthy coping mechanisms to deal with stress. IMPLICATION FOR NURSING PRACTICE: Study data informs healthcare providers that psychological distress and mental health warrants increased attention during periods of heightened stress. Education and resources on healthy, beneficial coping strategies should be provided to support HCT patients. Nurses and advanced nurse practitioners are well poised to interact with HCT patients and provide necessary support or appropriate referral during routine clinical interactions, preparing patients for prolonged effects of the pandemic and similar future events.

Impact of the COVID-19 pandemic on cancer patients and psycho-oncology providers: Perspectives, observations, and experiences of the American Psychosocial Oncology Society membership.

OBJECTIVE: To understand: (1) psycho-oncology providers' perspectives on and observations of the psychological responses of their cancer patients during the pandemic, and (2) psycho-oncology providers' own experiences delivering care. METHODS: In this concurrent mixed methods study, a survey was distributed to psychosocial providers who were members of the American Psychosocial Oncology Society (APOS). Survey respondents were invited to participate in a one-on-one audio-recorded interview via phone or secure Zoom®. RESULTS: seventy-six self-identified psycho-oncology providers responded to the survey and 11 participated in a one-on-one interview. Approximately half reported that patients responded in unique ways to COVID-19 stress relative to other populations. Three themes emerged from qualitative analyses: (1) unique burden on patients, (2) cancer patients' pandemic response and its relationship to their cancer experience, and (3) unexpected positive changes. Providers emphasized that the cancer experience may have prepared patients for the existential distress of the pandemic and described patients' resiliency. Two themes emerged regarding delivery of care: (1) new professional and personal challenges and (2) provider resiliency. CONCLUSIONS: Although providers observed that the pandemic placed new burdens on patients, they emphasized that the cancer experience may have prepared patients for the existential distress of the pandemic and described patients' resiliency. To overcome challenges, psycho-oncology providers used innovative strategies to support patients and foster their own mental health.