Depression and anxiety in patients with hematological malignancies, prevalence, and associated factors

A chain mediation model reveals the association between metacognition and quality of life in hematologic tumor patients

The study aims to explore the relationship among metacognition (MC), fear of disease of progression (FoP), psychological distress (PD), and quality of life (QoL), and verify whether FoP and PD have a chain mediating effect between MC and QoL. 231 hematologic tumor patients in a large tertiary hospital were investigated by using Meta-Cognitions Questionnaire-30, Fear of Progression Questionnaire-Short Form, Hospital Anxiety and Depression Scale, and Functional Assessment of Cancer Therapy scale. Data analyses were performed using IBM SPSS (version 25.0) and the PROCESS macro (version 4.1). The results showed that the direct impact of MC on QoL was not statistically significant. However, the indirect influence of MC on QoL manifest through the independent influences of PD and FoP, as well as the chain mediating effect of "PD → FoP." In addition, all four dimensions of QoL (physical, social and family, emotional, and functional) satisfy the chain mediation model, except for the social and family domain. These insights advance our comprehension of the intricate interplay between MC and QoL, underscoring the importance of improving MC to alleviate patients' PD, mitigate FoP, and ultimately improve the QoL of hematologic tumor patients.

Depression in patients with hematologic malignancies: The current landscape and future directions

Patients with hematologic malignancies experience high rates of depression. These patients are vulnerable to depression throughout the disease trajectory, from diagnosis to survivorship, and at the end of life. In addition to the distressing nature of depression, it has substantial downstream effects including poor quality of life, increased risk of treatment complications, and worse survival. Therefore, systematic screening for depression and integration of robust psychological interventions for affected patients is crucial. Although depression has been historically studied mostly in patients with solid malignancies, research focusing on patients with hematologic malignancies is growing. In this article, we describe what is known about depression in patients with hematologic malignancies, including its assessment, prevalence, risk factors, and implications. We also describe interventions to ameliorate depression in this population. Future research is needed to test effective and scalable interventions to reduce the burden of depression among patients with blood cancers.

[Adherence to treatment of hematological malignancies patients with anxiety and depression]

AIM

To establish the features of the influence of anxiety and depressive disorders on treatment adherence, as well as to clarify the factors associated with it in hematologic malignancies patients.

MATERIALS AND METHODS

The study included 117 patients: 51 men and 66 women, aged 19 to 67 years, with Hodgkin's lymphoma - 88, acute lymphoblastic leukemia - 16 and aplastic anemia - 13 patients. Patients were examined by psychiatrist using the Brief Psychiatric Rating Scale, as well as some psychometric methods.

RESULTS

Anxiety-depressive spectrum disorders were detected in 36 (40.9%) patients with Hodgkin's lymphoma and 8 (50%) with acute lymphoblastic leukemia, in the aplastic anemia group there were three (23.1%) of such patients. It was found that the average adherence to treatment was in 2/3 of patients, low and high - in the remaining 1/3 of patients. With medium and low adherence to treatment, the risk of adverse events increases by an average of 1.7 times. The adherence to treatment it is significantly higher in patients older than 45 years. Signs of depression that negatively correlated with adherence to treatment were pessimism and disruption of social ties. Adherence to treatment significantly positively correlates with the following types of attitudes towards the disease: anosognosic, hypochondriac and egocentric, and significantly negatively correlates with the following types of attitudes towards the disease: anxious, melancholic and dysphoric.

CONCLUSION

Anxiety/depressive disorders contribute to reduced adherence of hematologic malignancies patients to treatment. Their correction and increased adherence should be carried out jointly by hematologists and mental health professionals.

A systematic review to explore the effectiveness of physical health and psychosocial interventions on anxiety, depression and quality of life in people living with blood cancer

PROBLEM IDENTIFICATION

Anxiety and depression are more prevalent in hematological cancer patients who experience unpredictable illness trajectories and aggressive treatments compared to solid tumor patients. Efficacy of psychosocial interventions targeted at blood cancer patients is relatively unknown. This systematic review examined trials of physical health and psychosocial interventions intending to improve levels of anxiety, depression, and/or quality of life in adults with hematological cancers.

LITERATURE SEARCH

PubMed and CINAHL databases were used to perform a systematic review of literature using PRISMA guidelines.

DATA EVALUATION/SYNTHESIS

Twenty-nine randomized controlled trials of 3232 participants were included. Thirteen studies were physical therapy, nine psychological, five complementary, one nutritional and one spiritual therapy interventions. Improvements were found in all therapy types except nutritional therapy.

CONCLUSIONS

Interventions that included personal contact with clinicians were more likely to be effective in improving mental health than those without.

IMPLICATIONS FOR PSYCHOSOCIAL ONCOLOGY

Various psychosocial interventions can be offered but interactive components appear crucial for generating long-standing improvements in quality of life, anxiety and depression.

Examining the levels of psychological support available to patients with haematological cancer in England: a mixed methods study

OBJECTIVES

The psychological impact of a haematological malignancy is well documented. However, few studies have assessed the provision of psychological support to people with these diagnoses. This study explores the extent and nature of psychological support for people diagnosed with haematological cancer to inform future service provision.

DESIGN

This study consisted of an online survey with healthcare professionals (phase 1) and qualitative interviews with patients (phase 2) and key health professionals (phase 3). A descriptive analysis of survey data and thematic analysis of interviews were conducted.

PARTICIPANTS

Two hundred health professionals practising in England completed the survey. Twenty-five interviews were conducted with people diagnosed with haematological cancer in the past 3 years, and 10 with key health professionals, including haematologists, cancer nurse specialists and psychologists were conducted.

PRIMARY OUTCOME MEASURES

Level of psychological assessment undertaken with people with haematological cancer, and level and nature of psychological support provided.

RESULTS

Less than half (47.3%) of survey respondents strongly agreed/agreed that their patients were well supported in terms of their psychological well-being and approximately half (49.4%) reported providing routine assessment of psychological needs of patients, most commonly at the time of diagnosis or relapse. Patients described their need for psychological support, their experiences of support from health professionals and their experiences of support from psychological therapy services. There was considerable variation in the support patients described receiving. Barriers to providing psychological support reported by health professionals included time, skills, resources and patient barriers. Most doctors (85%) and 40% of nurse respondents reported receiving no training for assessing and managing psychological needs.

CONCLUSIONS

Psychological well-being should be routinely assessed, and person-centred support should be offered regularly throughout the haematological cancer journey. Greater provision of healthcare professional training in this area and better integration of psychological support services into the patient care pathway are required.

Effects of a Virtual Reality-Based Meditation Intervention on Anxiety and Depression Among Patients With Acute Leukemia During Induction Chemotherapy: A Randomized Controlled Trial

BACKGROUND

Emerging evidence supports that virtual reality (VR)-based meditation interventions may improve anxiety and depression among patients with cancer. However, empirical studies involving patients with acute leukemia during induction chemotherapy are limited.

OBJECTIVE

This study aimed to examine the effects of VR-based meditation intervention on alleviating anxiety and depression and improving the quality of life among patients with acute leukemia during induction chemotherapy.

METHODS

This randomized controlled trial recruited 63 patients newly diagnosed with acute leukemia. Participants were randomly assigned to an intervention group (received VR-based meditation for 20 min daily for 14 days) and a control group. Anxiety, depression, and quality of life were measured using the State Anxiety Inventory, the Center for Epidemiological Studies Depression Scale, and the Functional Assessment of Cancer Therapy-Leukemia Questionnaire, respectively. All outcomes were measured at baseline and post-intervention.

RESULTS

Compared with patients in the control group, those in the intervention group demonstrated a significantly greater reduction in anxiety (P = .04) and improvement in quality of life (P = .04). However, no significant difference was noted in depression levels between groups (P = .09), although a decreasing trend was observed in the intervention group.

CONCLUSION

Virtual reality-based meditation intervention effectively alleviated anxiety and improved the quality of life among acute leukemia patients during induction chemotherapy. Future randomized controlled trials with larger sample sizes and longer follow-up periods are warranted.

IMPLICATION FOR PRACTICE

Virtual reality-based meditation can be applied in clinical practice virtually anytime and anywhere to provide a convenient intervention for anxiety reduction for acute leukemia patients during induction chemotherapy.

Partnership, sexuality, and fertility-related communication: findings from a register-based study among long-term hematological cancer survivors

PURPOSE

Even though the number of hematological cancer survivors suffering from long-term and late consequences of their disease is growing, knowledge about their situation regarding partnership, sexuality, and fertility-related communication is sparse to date.

METHODS

We recruited survivors of hematological malignancies (≥ 3 years after diagnosis) from two cancer registries in Germany. We applied validated instruments and study-specific items on satisfaction with partnership, sexual functioning, and fertility-related communication with physicians. We provided descriptive statistics and conducted multiple regression analyses to identify associations of the outcomes with patient factors and well-being (anxiety, depression, and quality of life).

RESULTS

Of 2001 eligible survivors, 922 (46%) participated. Fifty-seven percent were male, and the mean age was 64 years. Ninety percent and 60% reported to be satisfied with their partnership and sexual life, respectively. However, 81% and 86% reported being sexually impaired by physical or mental symptoms, respectively. Seventy-four percent of those with incomplete family planning had a fertility-related conversation with a physician. Female gender (p < .05, Beta =  - .09), older age (p < .01, Beta = .10), and chemotherapy (p < .01, Beta = .10) were associated with less sexual pleasure caused by physical impairment. Satisfaction with partnership (p < .001, Beta = .22), satisfaction with sexual life (p < .001, Beta = .28), and conversation about fertility (p < .05, Beta = .26) were associated with better quality of life.

CONCLUSION

Even though long-term survivors seem to be generally satisfied with their partnership and sexual life, they may suffer from specific impairments. Our findings need to be verified in longitudinal studies.

A systematic review of coping skill interventions to reduce anxiety and depressive symptoms among adults with hematologic malignancies

BACKGROUND

Patients with hematologic malignancies experience anxiety and depressive symptoms from diagnosis through survivorship. The aim of this systematic review is to determine if coping skill interventions can reduce anxiety and depressive symptoms for persons with hematologic cancer.

METHODS

Databases including PubMed, Embase, CINAHL, APA PyschInfo, Scopus, and Cochrane were searched in June of 2021 for coping skill interventional studies with adult patients with hematologic cancer and outcomes of anxiety and depressive symptoms. Search terms, definitions, and inclusion/exclusion criteria were guided by the Transactional Model of Stress and Coping, and quality appraisal utilized the Johns Hopkins Evidence Based Practice Appraisal tool. The study was registered in PROSPERO under "CRD42021262967."

RESULTS

Eleven studies met inclusion criteria with ten studies evaluating anxiety symptoms and nine studies evaluating depressive symptoms. Of ten studies with 449 participants evaluating anxiety, five studies showed significant reduction (p < 0.05), three found small to moderate effect size reductions not reaching statistical significance (p > 0.05), and only two showed no reduction in anxiety symptoms. Of nine studies with 429 participants evaluating depressive symptoms, three had significant reductions (p < 0.05), three reported small to moderate effect size reductions not reaching statistical significance (p > 0.05), and three found no effect on depressive symptoms. Coping interventions that were problem-focused as opposed to emotion-focused were most effective for both anxiety and depressive symptoms.

CONCLUSION

This systematic review finds evidence that problem-focused coping interventions reduce anxiety symptoms among patients with hematologic malignancies, with mixed evidence for reduction of depressive symptoms. Nurses and other clinicians caring for patients with hematologic cancers may employ coping skill interventions as a potential way to mitigate anxiety and depressive symptoms.

PROSPERO REGISTRATION ID

CRD42021262967.

Prevalence of depression and associated factors among adult cancer patients receiving chemotherapy during the era of COVID-19 in Ethiopia. Hospital-based cross-sectional study

Background

Depression is a major public health problem among cancer patients undergoing chemotherapy. It compromises patient outcomes, resulting in higher rates of mortality. Currently, there are little data on the prevalence of depression in Sub-Sharan countries. Therefore, the current study was done to assess the prevalence of depression among adult cancer patients and its associated factors in Ethiopia.

Method

An institutional based cross-sectional study was conducted among 420 adult cancer patients from 1^st March to April 30, 2021. Systematic random sampling technique was used to recruit participants. Depression was assessed using the Patient Health Questionnaire-9. The collected data were coded and entered into Epi-data version 4.2 and exported to SPSS version 25 for analysis. Bivariate binary logistic regression was performed to select factors that will be included in multivariate analysis, and variables with a p-value < 0.05 were included in multivariate analysis. In multivariate analysis, odds ratios and their 95% confidence intervals were computed and variables with p-value < 0.05 were considered to declare a significant association.

Results

In this study, the prevalence of depression was 33.1% (95% CI = 0.2858, 0.3761). Minimal symptoms of depression, minor depression, moderate depression, moderate severe depression, and severe depression were found to be 272 (64.8%), 9 (2.1%), 104 (24.8%), 28 (6.7%), and 7 (1.7%), respectively. Those cancer patients who had unemployed status, sacked from jobs, and had stage IV cancer were most likely to develop depression, whereas patients who completed primary education, colon, prostate and cervical cancer were less likely to have depression.

Conclusion

Depression is found to be a major public health concern for adult cancer patients in Ethiopia. To reduce the occurrence of depression among cancer patients, special attention is needed.

Global, regional, and national prevalence of depression among cancer patients: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to provide a summary of the existing evidence on the prevalence of depression among cancer patients worldwide to assist health policymakers in adopting appropriate measures to prevent and control depression in these patients. EMBASE, Google Scholar, Scopus, PubMed, and Web of Science databases were searched for original studies published in English from January 2000 to July 2019. The studies were screened on the basis of quality and relevance criteria. The statistical analyses were conducted in the R software. Out of 182,521 cancer patients examined in 183 studies, 49,280 (~27%) had depression (95% confidence interval [CI] = 24%-30%). The highest prevalence of depression was among patients with colorectal cancer with 32% (95% CI = 20%-47%). Among countries, Pakistan with 43% (95% CI = 26%-64%), and among continents, Africa with 36% (95% CI = 29%-43%) had the highest prevalence of reported depression in cancer patients. Adjusting for sample size, the prevalence of depression among female cancer patients, 31% (95% CI = 26%-36%), was higher than men, 26% (95% CI = 21%-31%). The prevalence of depression among cancer patients is increasing by an average of 0.6% per year. The findings show higher prevalence of depression among cancer patients in underdeveloped and developing countries compared to the developed nations and the global average.

Predicting anxiety in cancer survivors presenting to primary care - A machine learning approach accounting for physical comorbidity

BACKGROUND

The purpose of this study was to explore predictors for anxiety as the most common form of psychological distress in cancer survivors while accounting for physical comorbidity.

METHODS

We conducted a secondary data analysis of a large study within the German National Cancer Plan which enrolled primary care cancer survivors diagnosed with colon, prostatic, or breast cancer. We selected candidate predictors based on a systematic MEDLINE search. Using supervised machine learning, we developed a prediction model for anxiety by splitting the data into a 70% training set and a 30% test set and further split the training set into 10-folds for cross-validating the hyperparameter tuning step during model selection. We fit six different regression models, selected the model that maximized the root mean square error (RMSE) and fit the selected model to the entire training set. Finally, we evaluated the model performance on the holdout test set.

RESULTS

In total, data from 496 cancer survivors were analyzed. The LASSO model (α = 1.0) with weakly penalized model complexity (λ = 0.015) slightly outperformed all other models (RMSE = 0.370). Physical symptoms, namely, fatigue/weakness (β = 0.18), insomnia (β = 0.12), and pain (β = 0.04), were the most important predictors, while the degree of physical comorbidity was negligible.

CONCLUSIONS

Prediction of clinically significant anxiety in cancer survivors using readily available predictors is feasible. The findings highlight the need for considering cancer survivors' physical functioning regardless of the degree of comorbidity when assessing their psychological well-being. The generalizability of the model to other populations should be investigated in future external validations.

Prevalence and factors associated with anxiety and depressive symptoms among patients hospitalized with hematological malignancies after chimeric antigen receptor T-cell (CAR-T) therapy: A cross-sectional study

BACKGROUND

We conducted a survey to investigate the prevalence and factors associated with anxiety and depressive symptoms among patients hospitalized with hematological malignancies after chimeric antigen receptor T-cell (CAR-T) therapy.

METHODS

In total, 130 eligible patients completed the Self-Rating Anxiety Scale and Self-Rating Depression Scale at week 4 after CAR-T cell infusion. We collected sociodemographic information during the same period. We studied factors associated with anxiety and depressive symptoms using logistic regression analysis.

RESULTS

The prevalence of anxiety and depressive symptoms at week 4 after infusion were 13.8% and 40.0%, respectively. A cutoff value of 50 or above indicates significantly anxiety and depressive symptoms. Binary logistic regression analysis showed that high school education and above (OR = 0.22, 95% CI = 0.06-0.78) and middle age (OR = 0.16, 95% CI = 0.03-0.90) were associated with lower risk of anxiety symptoms, and increased odds of depressive symptoms was associated with old age (OR = 11.39, 95% CI = 2.50-51.88), non-manual occupations before illness (OR = 3.72, 95% CI = 1.20-11.58), and higher healthcare expenditure (OR = 3.93, 95% CI = 1.50-10.33), while lower risk of depressive symptoms was associated with rural household location (OR = 0.25, 95% CI = 0.08-0.76) and being cared for by spouse (OR = 0.12, 95% CI = 0.02-0.63).

CONCLUSIONS

Patients receiving CAR-T therapy with lower education background, old ages, urban household location, or who used to work as non-manual workers require more attention and psychological care. Support from a spouse and medical expense deductions from the government may help patients develop positive attitudes.

Pre-transplant depression decreased overall survival of patients receiving allogeneic hematopoietic stem cell transplantation: a nationwide cohort study

Studies investigating association of depression with overall survival (OS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) yielded conflicting results. A nationwide cohort study, which included all adult patients [n = 7,170; depression group, 13.3% (N = 956); non-depression group, 86.7% (N = 6,214)] who received allo-HSCT from 2002 to 2018 in South Korea, analyzed risk of pre-transplant depression in OS of allo-HSCT. Subjects were followed from the day they received allo-HSCT, to occurrence of death, or last follow-up day (December 31, 2018). Median age at allo-HSCT for depression and non-depression groups were 50 and 45 (p < 0.0001), respectively. Two groups also differed in rate of females (depression group, 55.8%; non-depression group, 43.8%; p < 0.0001) and leukemia (depression group, 61.4%; non-depression group, 49.7%; p < 0.0001). After a median follow-up of 29.1 months, 5-year OS rate was 63.1%. Cox proportional-hazard regression evaluated an adjusted risk of post-transplant mortality related to depression: OS decreased sequentially from no depression (adjusted hazard ratio [aHR] = 1) to pre-transplant depression only (aHR = 1.167, CI: 1.007–1.352, p = 0.04), and to having both depression and anxiety disorder (aHR = 1.202, CI: 1.038–1.393, p = 0.014) groups. Pre-transplant anxiety (anxiety only) did not have significant influence in OS. Additional medical and psychiatric care might be necessary in patients who experienced depression, especially with anxiety, before allo-HSCT.

Quality of life and distress assessed with self and external assessment screening tools in patients with hematologic malignancies attending treatment in an acute hospital

Purpose

In this study, we examined distress levels and quality of life (QoL) of patients with hematologic malignancies under treatment in an acute setting. We used external- and self-assessment instruments for distress. Additionally, we investigated the relation between distress and QoL as well as whether highly distressed patients differed from less distressed patients concerning their QoL.

Methods

A cross-sectional study with patients of the Medical Clinic II of the University Hospital Frankfurt was conducted. One hundred and nine patients were assessed with an expert rating scale and completed self-report questionnaires. Data were exploratively analyzed and group comparisons between patients who scored above the cut-off of the respective screening instruments and those who did not were conducted.

Results

Patients with hematologic malignancies experience high levels of distress and low QoL. Especially, role and social functioning are affected. Patients suffer most from fatigue, appetite loss, and insomnia. Using established cut-offs, all screening instruments were able to differentiate between patients regarding distress and QoL. Patients scoring above the cut-off were significantly more distressed and had a lower QoL. There was a medium-to-strong correlation between distress and QoL indicators.

Conclusion

Cancer-specific screening instruments seem to be able to identify treatment needs more specifically. They also allowed a better differentiation concerning QoL. The close link between distress and QoL needs to be recognized to enable a holistic approach to treatment and thereby optimize the quality of treatment.

Autonomic nervous system control of multiple myeloma

The autonomic nervous system (ANS), which consists of antagonistic sympathetic (adrenergic) and parasympathetic (cholinergic) arms, has emerged as an important regulator of neoplastic development, yet little is known about its role in multiple myeloma (MM). Clinical findings that anti-adrenergic β-blocker intake reduces risk of disease-specific death and overall mortality in patients with MM have indicated that adrenergic input may worsen myeloma outcome. However, preclinical studies using β-adrenergic receptor agonists or antagonists produced controversial results as to whether sympathetic pathways promote or inhibit myeloma. Retrospective outcome data demonstrating that high message levels of cholinergic receptor genes predict inferior survival in the Multiple Myeloma Research Foundation CoMMpass trial suggest that parasympathetic input may drive myeloma progression in a subset of patients. Here we review the ill-defined role of the ANS in MM, put myeloma in the context of other cancers, and discuss knowledge gaps that may afford exciting research opportunities going forward.

The prevalence, risk factors, and prognostic value of anxiety and depression in refractory or relapsed acute myeloid leukemia patients of North China

This study aimed at investigating the prevalence of anxiety and depression, and their risk factors as well as their correlation with prognosis in refractory or relapsed (R/R) acute myeloid leukemia (AML) patients.A total of 180 R/R AML patients were enrolled and their anxiety and depression were assessed by Hospital Anxiety and Depression Scale (HADS) before treatment. Besides, HADS was also evaluated in 180 de novo AML patients prior treatment and 180 healthy controls (HCs), respectively.Both the HADS-Anxiety and HADS-Depression scores were increased in R/R AML patients compared with de novo AML patients and HCs (all P < .001). Meanwhile, the prevalence of anxiety and depression was 53.9% and 45.6% in R/R AML patients, which were also greatly higher compared with de novo AML patients and HCs (all P < .01). Regarding risk factors, higher Eastern Cooperative Oncology Group score and lines of salvage therapy were correlated with anxiety and depression in R/R AML patients (all P < .05). Furthermore, anxiety and depression were associated with shorter overall survival (OS) in R/R AML patients (all P < .05), while no association of different degrees of anxiety and depression with OS was observed (all P > .05).Anxiety and depression are highly prevalent and implicated in the management and prognosis of R/R AML.

Prevalence and Associated Factors of Depressive Symptoms in Patients with Myasthenia Gravis: A Cross-Sectional Study of Two Tertiary Hospitals in Riyadh, Saudi Arabia

Objectives

This study is aimed at elucidating the prevalence of depression in patients with myasthenia gravis (MG) and examining the risk factors associated with depression.

Methods

We evaluated adult patients with MG who were recruited from two tertiary hospitals in the central region (Riyadh) of Saudi Arabia. Data were collected with a two-part standardized questionnaire: the first part included data on sociodemographic and clinical features of MG including disease type and duration, therapies, prednisolone dose, time of the last relapse, previous critical care unit admissions, MG status (controlled, partially controlled, or uncontrolled), and comorbid diseases; the second part included items from the previously validated Arabic version of the Patient Health Questionnaire-9 (PHQ-9).

Results

In total, 104/150 (69.3%) patients participated (72 females) with a mean age of 38.0 ± 16.0 years. The mean PHQ-9 score was 7.02 ± 6.1. Among all the participants, 27 (26.0%) patients had depression (PHQ-9 ≥ 10). Multiple logistic regression analysis revealed that uncontrolled MG status (OR = 12.31, 95%CI = 1.13-133.8, P = 0.04) was the only factor independently associated with depression. Collectively, the prevalence of depression among patients of the primary care clinics (PCC) as reported by 5 previous studies across multiple regions of the country was 15.8%. The odds of depression among MG patients were twofold higher than those among PCC patients (OR = 2.05, 95%CI = 1.30-3.22, P = 0.002).

Conclusions

Approximately a quarter of MG patients have depression. Achieving a minimal manifestation or better MG status may decrease the depression rate in these patients.

Hematology and Depression Levels: Examining Correlated Factors Among Hospitalized Patients

BACKGROUND

Depression in patients with cancer negatively influences physical symptoms, treatment success, coping, and quality of life (QOL), and is associated with increased mortality.

OBJECTIVES

This study investigated the prevalence of depression and explored fatigue, QOL, and pain that is associated with depression in patients on first admission to a hematologic oncology unit.

METHODS

This descriptive study measured depression, QOL, and fatigue with the Patient Health Questionnaire-9, the Functional Assessment of Cancer Therapy (FACT)-General, and the FACT-Anemia scale, respectively. Pain levels were examined with a numeric rating scale.

FINDINGS

58 patients participated; 17 reported moderate to severe depression, which highly correlated with fatigue, QOL, and pain. Among all factors, multivariate analysis showed that fatigue, particularly the physical domain of fatigue, has the strongest reverse correlation with depression.

Serum Interleukin-6 is Not Linked with Sleep-Quality, Restless Legs Syndrome, and Depression, But with 6-Month Survival in Hematological Malignancies

Background:

Serum interleukin (IL)-6 has been found to be associated with sleep quality, mood, and survival in patients with solid tumors. Results in these studies were confounded by knowledge of diagnosis to study subjects. Moreover, such data among subjects with hematological malignancies and data regarding restless legs syndrome is limited. The present study was, therefore, conducted to assess the sleep quality, depression, and restless leg syndrome in hematological malignancies and to study if there is any role of IL6 associated with it.

Methods:

Sixty-six subjects having hematological malignancy were included in this study after excluding the potential confounders. Sleep quality was examined using Pittsburg Sleep Quality Index, depression by the Patient Health Questionnaire-9. Diagnosis of RLS was made through clinical examination. Serum for measurement of IL-6 was collected at baseline and after 1 month of initiation of chemotherapy. Patients were followed up for 6 months.

Results:

Average age of study subjects was 50.16 years with male predominance. Nearly 22.7% had clinical depression, 28.8% had poor quality sleep, and restless legs syndrome (RLS) was reported in 6.1% cases. Nearly 22.7% patients died at 6 months. Disturbed sleep at baseline was associated with depression (odds ratio [OR] =7.89) and poor 6 months survival. Serum IL-6 did not show any association with sleep quality, restless-legs-syndrome, and depression. However, baseline high level of serum IL-6 (OR = 26.06) and low level after chemotherapy (OR = 0.03) were associated with poor survival at 6 months.

Conclusion:

Poor quality sleep, depression, and RLS are prevalent among adult subjects with hematological malignancies. Sleep disturbance, high pretreatment inflammatory and lowering of inflammatory load after chemotherapy increase likelihood for poor prognosis. Serum IL-6 did not show any association with sleep quality, restless legs syndrome and depression.