Lovesick: Examining Couples Health during Myeloma Transplant

Introduction: Couples mutually influence one another’s’ physical and mental health trajectories, however a cancer diagnosis disrupts that connection. Multiple Myeloma (MM) is an incurable cancer, and patients remain on treatment indefinitely; thus patients and their spousal/partners face substantial long-term challenges including poor physical functioning, frailty, and emotional distress. Both patients and their spouse/partners have increased risk for heightened depressive and anxiety symptoms. Depression in MM patients has been reliably associated with poorer outcomes including greater 1-year post-Autologous Stem Cell Transplant (ASCT) mortality, and worse overall survival. Spouses/partners play a central role in the peri-ASCT preparation and recovery, and thus it is concerning that spouse/partner anxiety and depression often exceed that of patients. Here we examine the extent to which physical function, frailty, HRQoL and psychological distress, are interconnected among MM patients and their spouse/partner, as dyads, before and after MM ASCT.

Methods: Dyads (MM patients and spouse/partners) were enrolled in a prospective longitudinal study; assessments were administered prior to and post-ASCT at 90 days and 1 year. Measures included the Fried frailty phenotype, functional impairment [Short Physical Performance Battery (SPPB)], distress (Impact of Event Scale-Revised), depression [Center for Epidemiologic Studies Depression (CES-D)], couples’ satisfaction index (CSI-16), spousal strain (MIDUS), self-reported health [Karnofsky Performance Status (KPS) self), PROMIS HRQoL (Global 10, fatigue) were measured.

Results: Among dyads (n=62), pre-ASCT discordance in health measures (SPPB, IADL, fatigue, frailty) were evident with concordance among only social support (r=0.37, p=0.04) and self-reported health (KPS self, r=-0.41, p=0.02). Age was associated with lower functional scores [SPPB ß=-0.03 (SE:0.016), p=0.04] and men had greater changes in function peri-transplant [SPPB ß=0.92 (SE:0.329), p<0.01] compared to women. Among MM pts depression symptoms (CES-D) were significantly (p<0.01) associated with frailty (ß=0.05), and HRQoL (PROMIS Fatigue ß=0.61, PROMIS Global ß=-0.44) before and after transplant (not shown). The average distress effect on frailty was significant across groups. However, the distress effect in pts (ß=0.027 (SE: 0.008), p=0.0017) was greater than spouses (ß=0.003 (SE: 0.0096), p=0.77). ] Pre-ASCT, average couple satisfaction effect on self-reported health was significant (p=0.05), however the couple satisfaction effect was greatest in spouses [ß=0.49 (SE:0.121), p=<0.01]. Couples’ satisfaction was associated with improved physical function [SPPB ß=0.04 (SE:0.0213), p=0.05] pre-ASCT. Spousal strain impacted fatigue peri-ASCT [pre ASCT ß=4.44, (SE:2.37), p=0.07; post ASCT ß=3.81, (SE:1.83), p=0.05] and frailty only pre-ASCT [ß=0.52, (SE:0.24), p=0.04].

Conclusions: Physical frailty and psychologic distress are interconnected in MM patients and spouses. Importantly, the supportive role of spouse/partners and a couples’ perceived relationship health also impact MM ASCT recovery. Targeting programs for physical and emotional survivorship are imperative for both MM patient and spouse/partners.