Psychological well-being and social support in chronic myeloid leukemia patients receiving lifelong targeted therapies

Identifying the Risk Factors of Suicidal Ideation in Patients With Hematologic Malignancies Using a Multidimensional Approach

BACKGROUND

Patients with hematologic malignancies have a 3.5-fold higher rate of suicide completion than the noncancer population, and the Hodgkin lymphoma has the highest suicide rate among all cancers. Although the risk factors for suicidal ideation among the cancer population are well-known, the specific risk factors contributing to the high suicide rate among patients with hematologic malignancies are elusive.

OBJECTIVE

This study aimed to identify the risk factors for suicidal ideation among patients with hematologic malignancies using a multidimensional approach.

METHODS

This was a cross-sectional, observational study. A total of 163 patients were recruited from the oncology department of a university hospital. We collected data on psychological and physical symptoms, social support, and suicidal ideation using the Memorial Symptom Assessment Scale-Short Form, the Multidimensional Scale of Perceived Social Support, and the Suicidal Ideation Scale. Multiple regression analysis was performed using SPSS (version 26.0) to analyze the clinical data.

RESULTS

Among the 163 participants, 96 (58.9%) were male, 57 (35%) were diagnosed with acute leukemia, and 97 (59.5%) received chemotherapy. The mean age was 55.26 ± 15.75. Physical symptoms, psychological symptoms, and willingness to use mental health services accounted for 39.5% of suicidal ideation cases.

CONCLUSIONS

Assessment of psychological conditions at the beginning of diagnosis, provision of appropriate interventions throughout treatment, and follow-up care to relieve psychological symptoms should be initiated in patients with hematologic malignancies to prevent suicide.

Assessment of knowledge, attitudes, and practices of CML patients and their families toward TKI therapy in China

The introduction of tyrosine kinase inhibitors (TKIs) has revolutionized chronic myeloid leukemia (CML) treatment. The knowledge, attitude, and practice (KAP) of patients and their families play a significant role in treatment adherence and effectiveness. This study aimed to investigate the KAP of CML patients and their families regarding TKI therapy in China. From November 1 to December 31, 2022, a cross-sectional study was conducted at the Affiliated Huai'an No. 1 People's Hospital in China. A total of 313 CML patients and 268 family caregivers were selected using convenience sampling. Participants answered a self-designed questionnaire. The questionnaire contained demographic/clinical data and assessed KAP toward CML and TKI therapy. Participants exhibited mean KAP scores of 8.91 (55.7%), 33.10 (73.6%), and 2.20 (73.3%), respectively. Family members had higher knowledge and practice scores than patients (both P < .05), with factors such as younger age, urban residency, higher education, employment, higher income, and interaction with peers correlating with better knowledge scores (P < .001). Although participants were well-informed about their diagnosis and medication (>80%), understanding of disease causes (<30%) and treatment prognosis and side effects (<50%) was limited, and cost concerns affected 80.55%. Anxiety and depression were reported more among caregivers (46.64% and 13.8%) than patients (29.71% and 11.51%). While 84.85% adhered to the doctor's instructions, only 68.50% actively sought more CML information. Positive correlations were observed among KAP scores, indicating their interdependence (knowledge-attitude: R = 0.397; knowledge-practice: R = 0.598; attitude-practice: R = 0.353; all P < .001). The findings underscore the importance of tailored education to fill knowledge gaps about CML and the need to address financial concerns and provide psychological support. The positive correlations among knowledge, attitudes, and practices emphasize the need for comprehensive interventions. In conclusion, this study highlights the importance of tailored education, addresses financial concerns, and provides emotional support for CML patients and caregivers in China, despite limitations such as convenience sampling and questionnaire design. Future research should evaluate the effectiveness of educational interventions and long-term outcomes to further enhance the overall well-being of this population.

The Prospective Effects of Coping Strategies on Mental Health and Resilience at Five Months after HSCT

OBJECTIVES

Hematopoietic stem cell transplantation (HSCT) is a stressful event that engenders psychological distress. This study examines the prospective effects of coping strategies during hospitalization on resilience and on various mental-health dimensions at five months after transplantation.

METHODS

One hundred and seventy patients (M_age = 52.24, SD = 13.25) completed a questionnaire assessing adjustment strategies during hospitalization, and 91 filled out a questionnaire five months after HSCT (M_age = 51.61, SD = 12.93).

RESULTS

Multiple regression analyses showed that a fighting spirit strategy positively predicted resilience (p < 0.05), whereas anxious preoccupations predicted anxiety (p < 0.05), poorer mental QoL (p < 0.01), and were associated with an increased risk of developing PTSD (OR = 3.27, p < 0.01; 95% CI: 1.36, 7.84) at five months after transplantation. Hopelessness, avoidance, and denial coping strategies were not predictive of any of the mental health outcomes. Finally, the number of transplantations was negatively related to a fighting spirit (p < 0.01) and positively related to hopelessness-helplessness (p < 0.001): Conclusions: These results highlight the importance of developing psychological interventions focused on coping to alleviate the negative psychological consequences of HSCT.

The Psychological Adaptation Process in Chinese Parent Caregivers of Pediatric Leukemia Patients: A Qualitative Analysis

BACKGROUND

Psychological stresses caused by caring for pediatric leukemia patients can affect their parent caregivers' health. How these stressors are successfully managed determines how well these caregivers adapt to the illness situation over time. Previous studies suggest that caregivers will adapt gradually to the adverse consequences of caring for their child with a long-term illness. However, studies of the psychological adaptation process of family caregivers of children with leukemia are limited.

OBJECTIVE

The aim of this study was to study the psychological adaptation process of the parent caregivers of pediatric leukemia patients.

METHODS

In this qualitative study, we interviewed 32 caregivers of children with leukemia in China. Data were collected through semistructured interviews and analyzed using the content analysis method.

RESULTS

The psychological adaptation process in caregivers of pediatric leukemia patients seems to involve 5 stages: initial devastation, accumulation of hope, fluctuation in feelings, integration, and psychological adaptation. Significant emotional changes were observed at each stage.

CONCLUSIONS

This study identified commonalities in the psychological adaptation process experienced by caregivers of children with leukemia in the Chinese social and cultural context. It also characterized the different emotions that the caregivers had in the 5 stages of adaptation. In addition, our research identified the possible psychological interventions at different stages.

IMPLICATIONS FOR PRACTICE

The study described the adaptation process of Chinese parents of children with leukemia. The findings of this study will help nurses identify main coping resources, controllable intervention factors, and the timing of intervention for these caregivers of children with leukemia.

Assessment of the health utility of patients with leukemia in China

OBJECTIVES

This study aimed to assess the health utility of leukemia patients in China using the EQ-5D-5L, compare it with the population norms, and identify the potential factors associated with health utility.

METHODS

A hospital based cross-sectional survey was conducted in three tertiary hospitals from July 2015 to February 2016. A total of 186 patients with leukemia completed the EQ-5D-5L and their health utility scores were calculated using the Chinese value set. EQ-5D-5L utility and dimensions scores of leukemia patients were compared with China's population norms using Kruskal-Wallis test and chi square test. Potential factors associated with health utility were identified using Tobit regression.

RESULTS

The mean EQ-5D-5L utility scores of patients with leukemia, grouped by either gender or age, were significantly lower than those of the general population (p < 0.001). The same results were found for individual dimensions of EQ-5D-5L, where leukemia patients reported more health problems than the general population (p < 0.001). The utility score of leukemia patients was found to be significantly related to medical insurance, religious belief, comorbidities, social support and ECOG performance status.

CONCLUSION

This study indicated that leukemia patients have worse health status compared to the general population of China and that multiple factors affect the health utility of the patients. The utility scores reported in this study could be useful in future cost-utility analysis.

Psychological aspects in patients with advanced cancer receiving lifelong systemic treatment: protocol for a scoping review

INTRODUCTION

A better understanding of the molecular, genetic and immunological characteristics of cancer and the introduction of new systemic treatment regimens in the last decades, has led to better treatment outcomes and increased survival rates for patients with previously short lived cancers. However, there is no uniform description to refer to this growing group of patients with advanced cancer who now respond to new systemic treatments for longer periods. Furthermore, little is known about the unique psychological challenges these patients face, living with ongoing uncertainty about the course of their disease and life expectancy. The objective of this scoping review is to identify the psychological aspects experienced by, and the definitions used to refer to patients with advanced cancer receiving lifelong systemic treatment.

METHODS AND ANALYSIS

This review will be among the first to summarise literature on the psychological issues in the growing group of advanced cancer patients undergoing long-term systemic treatment. Articles will be retrieved from six databases (MEDLINE, Embase, Web of Science, PsycINFO, CINAHL and the Cochrane Database of Systematic Reviews) and reviewed for eligibility by two investigators independently. Definitions and psychological challenges will be extracted and narratively summarised following a descriptive approach. Furthermore, results will contribute in providing a uniform definition for this patient group, and help to identify knowledge gaps to give direction to further research in this field.

ETHICS AND DISSEMINATION

No ethical approval is required. The results of the scoping review will be submitted for publication to a scientific journal and presented at relevant conferences.

Mental Health in Persons With Chronic Myeloid Leukemia During the SARS-CoV-2 Pandemic: The Need for Increased Access to Health Care Services

Mental health problems in the general population have been reported during the SARS-CoV-2 pandemic; however, there were rare data in persons with chronic myeloid leukemia (CML). Therefore, we performed a cross-sectional study on mental health evaluated using the 9-item Patient Health Questionnaire (PHQ-9; depression), the 7-item Generalized Anxiety Disorder (GAD-7; anxiety), and the 22-item Impact of Event Scale-Revised (IES-R; distress), including subscales of avoidance, intrusion, and hyper-arousal in persons with CML, non-cancer persons, and immediate family members of persons with cancer as controls (≥16 years) by an online survey. Data from 3,197 persons with CML and 7,256 controls were collected. In multivariate analyses, CML was significantly associated with moderate to severe depression (OR = 1.6; 95% Confidence Interval [CI], 1.4, 1.9; p < 0.001), anxiety (OR = 1.4 [1.1, 1.7]; p = 0.001), distress (OR = 1.3 [1.1, 1.5]; p < 0.001), and hyper-arousal (OR = 1.5 [1.3, 1.6]; p < 0.001). Moreover, delay in regular monitoring was significantly associated with depression (OR 1.3 [1.0, 1.7]; p = 0.024), anxiety (OR = 1.3 [1.0, 1.8]; p = 0.044), avoidance (OR = 1.2 [1.0, 1.4]; p = 0.017), and intrusion (OR = 1.2 [1.0, 1.4]; p = 0.057); tyrosine kinase-inhibitor dose reduction or discontinuation, depression (OR = 1.9 [1.3, 2.8]; p = 0.001), distress (OR = 2.0 [1.4, 2.8]; p < 0.001), avoidance (OR = 1.6 [1.2, 2.1]; p = 0.004), intrusion (OR = 1.6 [1.1, 2.1]; p = 0.006), and hyper-arousal (OR = 1.3 [1.0, 1.8]; p = 0.088). We concluded that persons with CML during the SARS-CoV-2 pandemic have worse mental health including depression, anxiety, and distress symptoms. Decreasing or stopping monitoring or dose resulted in adverse mental health consequences.

Variables associated with self-reported anxiety and depression symptoms in patients with chronic myeloid leukemia receiving tyrosine kinase inhibitor therapy

Variables associated with self-reported anxiety and depression symptoms were explored in 1169 adults with chronic myeloid leukemia (CML) receiving tyrosine kinase inhibitor (TKI)-therapy. The Self-Rating Anxiety Scale and Self-Rating Depression Scale questionnaires were used to measure anxiety and depression symptoms. Two hundred and fifty-one (22.4%) and 415 (37.1%) respondents reported anxiety and depression, respectively. In multivariate analyses, female sex, lower education level, comorbidities, advanced-line TKI-therapy, and longer TKI-therapy duration were significantly associated with more severe anxiety and/or depression. It is concluded that socio-demographics, comorbidities, advanced-line TKI-therapy, and longer TKI-therapy duration were significantly associated with anxiety and/or depression symptoms in CML patients receiving TKI-therapy.

Relationship of Physicians' Rapport with Patients' Satisfaction and Psychological Well-being During Hospitalization

Objective The purpose of this study was to assess the association between the psychological well-being and satisfaction of patients with physicians during their hospitalization. Methods This cross-sectional study was conducted at a local hospital using the following surveys: Brief Inventory of Thriving (BIT), tool to assess inpatient satisfaction with care from hospitalists (TAISCH) survey, and Erlanger Internal Patient satisfaction survey addressing demographic questions and questions on physicians' quality of care and etiquette. Mixed linear regression models were created to examine the effect of psychological well-being on patient satisfaction. Models were adjusted for age, race, and gender, and all analyses were performed in R 3.1.1 using the 'lme4' package with statistical significance set at p<0.05. Results A total of 360 patients were enrolled in this analysis and the mean age of the cohort was 54.5 years. In the unadjusted analysis, each unit increase in BIT score was associated with a 0.3% (95% CI:0.19-0.4, p<0.001) increase in mean satisfaction score using the five-domain questionnaire and a 0.25% (95%CI:0.16-0.34, p<0.01) increase in mean satisfaction score using the TAISCH questionnaire. Multivariable models, after adjusting confounding variables, also showed the direct and statistically significant relationship between patients' level of psychological well-being and patient satisfaction. Each unit increase in BIT score was associated with a 0.31% (95% CI:0.20-0.43, p<0.001) and 0.26% (95% CI:0.17-0.36, p<0.001) increase in mean satisfaction scores across the five-domain questionnaire and TAISCH questionnaire. Conclusions There is a positive correlation between the level of patients' psychological well-being and satisfaction with his/her physician with a statistical significance. With patient-specific strategies, we can further improve patient rapport with their physicians, resulting in positive patient outcomes.

Impact of dosing frequency (once daily or twice daily) on patient adherence to oral targeted therapies for hematologic malignancies: a retrospective cohort study among managed care enrollees

Purpose

Existing studies evaluating patient adherence to oral targeted therapies such as tyrosine kinase inhibitors focus on small populations with single malignancies. This study evaluated patterns of use of oral agents in a larger population across multiple hematologic malignancies.

Methods

Adult patients diagnosed with a hematologic malignancy and prescribed oral targeted therapy between 2011 and 2016 (N = 18,976) were identified from the MarketScan Commercial Claims and Encounters, and Medicare Supplemental databases. Eligible patients were enrolled in monthly prescription plans 6 months before and 12 months after the index date (date of first prescription claim; n = 2442). Multivariable logistic regressions were used to determine predictors of adherence using the medication possession ratio (MPR) and persistence through prescription refill gaps.

Results

The overall median adherence was 0.9 (MPR ≥ 80%) and was comparable between once-daily (QD) and twice-daily (BID) groups. Overall, 59% of patients were persistent at 12 months. Patients on QD and BID products did not have any significant differences in adherence (fixed-interval MPR, odds ratio 0.94; 95% confidence interval (CI), 0.75–1.18) or persistence (odds ratio 0.93; 95% CI, 0.75–1.17) 12 months from index. Significant predictors of adherence and persistence included patient age, total inpatient admissions, number of adverse events, and total hospital visits.

Conclusion

Patient-specific clinical factors, rather than regimen-specific factors, were the main predictors of oral targeted therapy adherence and persistence. Adherence to oral targeted therapies appears to be similar for patients on QD and BID regimens in the real-world setting.

Health-related quality of life in lower-risk MDS patients compared with age- and sex-matched reference populations: a European LeukemiaNet study

In myelodysplastic syndromes (MDS), health-related quality of life (HRQoL) represents a relevant patient-reported outcome, which is essential in individualized therapy planning. Prospective data on HRQoL in lower-risk MDS remain rare. We assessed HRQOL by EQ-5D questionnaire at initial diagnosis in 1690 consecutive IPSS-Low/Int-1 MDS patients from the European LeukemiaNet Registry. Impairments were compared with age- and sex-matched EuroQol Group norms. A significant proportion of MDS patients reported moderate/severe problems in the dimensions pain/discomfort (49.5%), mobility (41.0%), anxiety/depression (37.9%), and usual activities (36.1%). Limitations in mobility, self-care, usual activities, pain/discomfort, and EQ-VAS were significantly more frequent in the old, in females, and in those with high co-morbidity burden, low haemoglobin levels, or red blood cells transfusion need (p < 0.001). In comparison to age- and sex-matched peers, the proportion of problems in usual activities and anxiety/depression was significantly higher in MDS patients (p < 0.001). MDS-related restrictions in the dimension mobility were most prominent in males, and in older people (p < 0.001); in anxiety/depression in females and in younger people (p < 0.001); and in EQ-VAS in women and in persons older than 75 years (p < 0.05). Patients newly diagnosed with IPSS lower-risk MDS experience a pronounced reduction in HRQoL and a clustering of restrictions in distinct dimensions of HRQoL as compared with reference populations.

Higher out-of-pocket expenses for tyrosine kinase-inhibitor therapy is associated with worse health-related quality-of-life in persons with chronic myeloid leukemia

PURPOSE

To explore health-related quality-of-life (HRQoL) profiles and identify socio-demographic and clinical variables associated with HRQoL in persons with chronic myeloid leukemia (CML) receiving tyrosine kinase inhibitors (TKIs).

METHODS

A cross-sectional questionnaire was distributed to adults with chronic-phase CML receiving tyrosine kinase-inhibitor (TKI) therapy >3 months in complete cytogenetic response (CCyR). Respondents were anonymous. SF-36 Health Survey was used to measure HRQoL.

RESULTS

Data from 828 respondents were analyzable. 524 (63%) were male. Median age was 42 years (range 18-88 years). 648 (78%) were receiving imatinib. Median TKI-therapy duration was 36 months (range 3-178 months). 638 (77%) paid some or all of their TKI costs. Annual out-of-pocket expenses >$4600 USD was associated with lower physical component summary (PCS; -2.8 to -3.8; P = 0.0081 and 0.0009) and mental component summary (MCS; -2.1 to -4.3; P = 0.0394 and 0.0080) in multivariate analyses. Other variables significantly associated with a lower PCS and/or MCS included: (1) female sex; (2) increasing age; (3) education level < bachelor degree; (4) co-morbidity(ies); and (5) generic drug use. TKI-therapy duration 3-5 years was associated with higher PCS and MCS.

CONCLUSIONS

Higher out-of-pocket expense for TKI therapy is significantly associated with worse HRQoL in persons with chronic-phase CML in CCyR receiving TKI therapy. These data indicate the importance of drug cost and health insurance policies on people's HRQoL.

Variables associated with patient-reported outcomes in persons with chronic myeloid leukemia receiving tyrosine kinase-inhibitor therapy

PURPOSE

Explore patient-reported outcomes (PROs), including health-related quality of life (HRQoL), satisfaction with therapy, impact of the therapy on work and daily life, and concerns related to the therapy and identify variables associated with PROs in persons with chronic myeloid leukemia (CML) receiving tyrosine kinase inhibitors (TKIs).

METHODS

Across-sectional questionnaire was distributed to adults with chronic phase CML and answered anonymously. SF-36 Health Survey was used to measure HRQoL. Our focus was on the physical component summary (PCS) and mental component summary (MCS) components.

RESULTS

Data from 819 respondents receiving TKI-therapy ≥3 months and achieving a complete cytogenetic response were analyzed. Median age was 42 years (range 18-88 years). 652 (80%) were receiving imatinib. Median TKI-therapy duration was 36 months (range 3-178 months). 629 (77%) paid some or all of their TKI costs. In multivariate analyses, female sex, increasing age, lower education level, increasing co-morbidities, concomitant medication, ≥3 symptoms, moderate or severe symptom, switch from imatinib to a second-generation TKI, and higher annual out-of-pocket expense of TKI were significantly associated with lower PCS and/or MCS. However, TKI-therapy duration 3-7 years was significantly associated with better well-being. Higher PCS or MCS score was significantly associated with higher satisfaction level with TKI-therapy and less impact of TKI-therapy on subject's daily life and work. In addition, adverse impact on daily life and work was significantly associated with more interests in TKI-therapy-related issues.

CONCLUSIONS

Social-economic and clinical variables were significantly associated with PROs in persons with CML receiving TKI-therapy.