Pilot Study of Parent Psychophysiologic Outcomes in Pediatric Hematopoietic Stem Cell Transplantation

Background: Parents of children undergoing hematopoietic stem cell transplantation (HSCT) are at risk for psychological distress. This distress may result in aberrant immune, inflammatory, or endocrine effects. These physiologic outcomes have not been reported previously. Main Objective: The aim of this study is to examine the feasibility of longitudinal testing of psychophysiological parameters of stress in parents of children undergoing HSCT. Methods: This pilot study was conducted at a large children's hospital in the Midwest and included parents of children who received autologous or allogeneic HSCT. Time points included before the start of HSCT conditioning and day + 30, + 60, and + 100. Outcome variables included parent-perceived stress, lymphocyte subsets, C-reactive protein (CRP), proinflammatory cytokines, salivary cortisol, and salivary amylase. Effect sizes were calculated for each outcome. Results: Twelve parent-child dyads were enrolled (10 mothers, 2 fathers). Missing data were minimal. Parent-perceived stress significantly increased from pre-HSCT through day + 100, and parent CD3+ T-lymphocyte counts decreased from pre-HSCT through day + 100. No significant effects were observed for salivary studies, CRP, or proinflammatory cytokines. Effect sizes ranged from 1.23 (perceived stress) to 0.07 (CRP). Conclusion: The results of this study suggest that it is feasible longitudinally measure parent psychophysiologic outcomes in the pediatric HSCT setting. In addition, parent-perceived stress increased linearly from start of conditioning through day + 100, whereas parent T-lymphocyte counts decreased concurrently. Implications for Practice: Routine psychological and physical health screening of parents of children undergoing HSCT is needed. Multidisciplinary psychosocial support services should be offered to parents at regular intervals during their child's HSCT.