STEPs to Enhance Early Recovery after Hematopoietic Stem Cell Transplantation

Dates: 9/1/2015 - 2/28/2017

Co-Investigators:  Eileen Hacker, Chang Gi Park

Abstract:  Purpose/Specific Aims: High-dose chemotherapy (HDC) followed by hematopoietic stem cell transplantation (HCT) is a curative treatment for hematologic malignancies, but it is associated with high 100-day treatment-related mortality and devastating complications. Survivors report severe fatigue coupled with substantial reductions in physical activity.  Sustained physical inactivity after HCT is sufficient to cause muscle mass loss with resulting decreases in strength. This pilot study will test and refine a free-living physical activity intervention, Steps to Enhance Early Recovery (STEPS), after HCT. The STEPS intervention is particularly attractive, if proven successful, given the potential ease of clinical implementation without the costly need for expensive human and capital resources.

The specific aims are:

  1. Test and refine the STEPS intervention to evaluate acceptability and feasibility.
  2. Determine the preliminary effects of STEPS on physical activity, fatigue, muscle strength, functional ability, and quality of life.
  3. Test the feasibility and acceptability of subject preference for choosing the physical activity tracker.

Rationale/Significance of the Study: Our goal is to facilitate the early recovery of HCT recipients by developing effective interventions to alleviate symptoms, promote functional independence, and improve quality of life. HDC and HCT often results in significant physical deconditioning particularly during the early recovery phase. The immediate goal of this research is to intervene early in the recovery process to decrease and/or alleviate the impact. Increasing physical activity while the cancer patient is in the active phase of HCT treatment presents multiple challenges. The STEPS intervention is designed to overcome these challenges.
Main Research Variables: The STEPS intervention is the independent variable. The dependent variables include physical activity, fatigue, muscle strength, functional ability, and quality of life.

Design/Methods: A prospective, repeated measures design will be used. A convenience sample of adult HCT patients (n=10) will be recruited. The STEPS intervention consists of an educational component to be administered while the subject is hospitalized for HCT treatment followed by a six week comprehensive free-living physical activity program. The program includes goal setting and tracking to identify and implement 10% weekly increases in physical activity after release from the hospital. To track physical activity, subjects will choose a physical activity tracker based on individual preferences and needs. The dependent variables will be measured during two time periods: (a) prior to HCT; and, (b) six weeks following hospital discharge (T2).
External Funding Plan: This pilot study will refine and revise the STEPS intervention. The findings from this study will be used in conjunction with our currently funded study, Strength Training to Enhance Early Recovery (STEER) after HCT, to inform the next phase of our research program. Our plan is to conduct a three arm study comparing the proposed STEPS intervention to STEER along with a combination of the two.

Internal Research Support Program (IRSP)