Nearly one-quarter of patients with a myeloproliferative neoplasm (MPN) participating in a large international survey study met criteria for significant symptoms of depression, according to findings published in Cancer Medicine.

The Philadelphia chromosome-negative MPNs, which include polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF), are associated with clonal proliferation of differentiated hematopoietic cells, as well as a variety of constitutional symptoms, such as fatigue, pruritus, and night sweats, that can adversely affect patient quality of life. However, less is known about the frequency of depressive symptoms in this population of patients.

This study utilized responses to a 70-item, Internet-based questionnaire previously administered as part of a study hosted by the Mayo Clinic Survey Research Center in Rochester, Minnesota, that was designed to evaluate fatigue and mood symptoms in patients with an MPN.

As part of the original study, patient participants completed the Patient Health Questionnaire-2 (PHQ-2), a screen for depression, as well as the Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF) and the Brief Fatigue Index (BFI). A PHQ-2 score of 3 or higher was considered a marker of depression. Self-reported patient demographic information was also collected.


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The main aim of this analysis was to evaluate whether depressive symptoms in patients with MPNs are associated with other characteristics of these diseases, including constitutional symptoms, as well as specific patient-related factors.

Of the 1334 survey respondents included in this analysis, 309 (23%) scored a 3 or higher on the PHQ-2 screening tool. No significant differences in the percentages of patients with ET, PV, and MF (P =.78) who met the criteria for depression were noted, but those with disease characterized by a JAK V617F mutation (P =.0161) and those with higher levels of education (P <.0001) were significantly less likely to report depressive symptoms

Patient- and disease-related factors significantly associated with an increased likelihood of depression included younger age (P =.003), increased emotional stress (P ≤.0001), recent disruptions in sleep (P <.0001), cigarette smoking (P =.0003), and a history of thrombosis (P =.007), as well as active use of prescription pain medication (P <.0001), antidepressants (P <.0001), and anxiety medications (P =.0005).  

A key study finding was that self-reported depressive symptoms were significantly associated with an increased likelihood of experiencing constitutional symptoms of MPN, including fatigue, according to the MPN-SAF (P <.001) and BFI (P <.001). Furthermore, those with a PHQ-2 score of 3 or higher were more likely to experience fatigue throughout the day (P <.0001) as opposed to those with a PHQ-2 score of less than 3, who were more likely to report fatigue in the evening (P <.001). 

“The association of MPN constitutional symptoms with prominent depressive symptoms suggests that heavy constitutional symptom burden leads to depressive symptoms and addressing the MPN symptom severity, through pharmacological or nonpharmacological therapies, may improve symptoms of depression,” the investigators noted.

They further added that “prominent depressive symptoms may worsen the severity of systemic symptoms experienced by MPN patients and utilizing psychological therapy to address the underlying mood disorder may lessen MPN symptoms.”

“Based on these findings, the clinical suspicion for depression in MPN patients should be high, and screening for depression should be routine in this patient population,” the investigators concluded.

Disclosures: Multiple authors declared affiliation with industry. Please refer to the original article for a full list of disclosures.

Reference

Padrnos L, Scherber R, Geyer H, et al. Depressive symptoms and myeloproliferative neoplasms: Understanding the confounding factor in a complex condition. Cancer Med. Published online September 25, 2020. doi:10.1002/cam4.3380