Lovesick: Examining Couples Health During Myeloma Transplant | Ashley Rosko, MD | #ASH24

Hi there.
My name is Ashley Rosko.
I am a professor in the Division of Hematology at the Ohio State University.
I'm the medical director of the Onco geriatric program.
At the American Society of Hematology, I presented on lovesick, which is about couples health before and after autologous stem cell transplant for patients,
and partners of those who have multiple myeloma.

So our study focused on, the physical health and mental health
and the couples health for patients who are diagnosed with multiple myeloma.

So in our study,
and this is a preliminary analysis in which we explored dyads, which is both,
a patient and a partner, to be able to better identify
the trajectories of health before and after a stem cell transplant.

So importantly, in our study, what we identified in our preliminary
analysis is that we are exploring patients mental health,
physical health in couples satisfaction during that period of time.

So what we identified initially is that we know that during
the course of transplant, we know that age also can impact, couples health as well.
And so we found that with before and after transplant age
adversely impact, functional status during transplant.

We also identify for patients, who had a strong couples satisfaction
that that was associated with improved, depression
scores and improved overall quality of life.

We also found that in couples satisfaction that was associated with improved
physical function for patients diagnosed with multiple myeloma.

So these are important aspects of health
to not only to be able to identify the trajectories of patients,
but also to identify the trajectories of their partners
and how that can influence one another, and how we can capitalize on a strong bond
between a patient and a partner to be able to improve outcomes for patients with
multiple myeloma.

So importantly when an individual is diagnosed with a malignancy,
it has this rippling effect where it not only impacts the patient,
but it impacts, the caregivers that it can back the partner.
And so we want to be able to better identify and dissect that,
what we did identify for patients that, it can be discordant
in terms of how different things, it can impact patients.

We found, for example, that distress for the patients,
significantly impacted their frailty.
But distress for the partner did not.

So that's an example of how we can be able to better dissect, health factors
and also mental health factors in terms of being able to identify them.
And improve upon them.

For transplant physicians.

Over a decade ago,
it was identified
for people who have, social support and particular spousal support
that improved cancer outcomes when it came to the diagnosis and treatment
and long term outcomes for patients diagnosed with multiple myeloma.

And that data has been published and reproduced many different times.
But having, spouse in it itself is not necessarily protective.
It's really the strength of that relationship
is that there's a strong, supportive relationship
that can be really impactful for a patient who is diagnosed with multiple myeloma.

In our analysis, we are able to study different types
of, physical health, mental health and psychosocial support
using self-reported tools, validated instruments
to not only explore things like depression, but also loneliness,
to be able to explore things like couple satisfaction, couple strange.
And there are different types of instruments.
We used to be able to measure those and partnership with our team,
with the Institute for Behavioral Medicine Research at Ohio State.
We're able to synergize our work in multiple myeloma
with that and psychology.

So what would an ideal survivorship program
look like for patients diagnosed with multiple myeloma?
And early survivorship starts at the time of diagnosis.
And what we identified in
our data is being able to identify if there is couples strain.
Having support services, whether that's through psychosocial oncology
or couples counseling,
may be very beneficial to be able to improve
the overall trajectories of patients diagnosis of myeloma.

So importantly, when we talk about psychosocial support, that can mean
many different things that may need to be, you know, patient counseling.
It could need to be partners, counseling and then also couples counseling
and that various about the services that are available from institution
to institution.

But identifying those factors early, I think, are really what's important.
And what we identified in our data set is that
these are patients who are newly diagnosed and we kind of,
ask questions about their caregiver, but it's oftentimes been outside of the scope
of the treating physician to be able to get a better sense of,
how that partnership, is functioning.

But I think what we've really identified is that merely identifying a caregiver,
merely identifying a partner that can help support them is probably not enough.
And being able to identify the strength of that relationship
and if there is strain, which it often is in the time when someone's diagnosed
with the cancer, to be able to put those support services in place sooner.

In a previous literature, in
our data sets, too, we've identified that Patients, partners have experienced
even higher anxiety, higher depression than the patient themselves.
And that is important for us to be able to recognize, like, why would that be?
Well, like, as I mentioned, you know, having a diagnosis of cancer
has this ripple effect.
And also it's a time of vulnerability in terms of not having control
and ability to be able to help and ability to be able to provide
ongoing support in the ways that sometimes patients need.
And that can be a very stressful period of time.

And and so oftentimes, you know, patients are partners, may be focused
well on the kind of the medical care, but not really realizing
that the mental health care is equally as important.

An important part about what we're looking at in
is this idea of this marital contagion is that, just similar
to emotional contagion, where there can be kind of unconscious behaviors,
that are elicited.

What we identify in a married couple to there can be
physical health changes that can also be shared.
And so we may if someone is getting sicker,
we don't necessarily know yet, but we're trying to explore
how that if someone's becoming more frail, how that impacts the partner as well.

Because again,
that's in the past really been outside of the scope of the treating physician.
But we are seeing this mirroring behaviors,
when it comes to things like body mass index,
when we are looking at things like, emotional support.

And in our larger data set, we're hoping to be able to identify
how these mirroring behaviors when it comes to frailty, can,
be capitalize on or whether or not.
So if, if a partner is stronger physically, whether or not we can
encourage, you know, for the patient and the partner to work together
on some of their physical health as well as some of their mental health.

Importantly,
our data is in our preliminary analysis that what we're
looking forward to is being able to look at the trajectories over time.
Our data is looking at patients, directly before transplant.
And then 90 days after transplant.
But of course, you know, we want to look at the sustainability and,
of these parameters, whether that's one year out or two years
out, to see how dynamic, these influences are for both mental
health and physical health, behavior change.