Prevalence, Severity of Psychological Distress Higher in Patients Coping With Philadelphia-negative Myeloproliferative Neoplasm

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A cancer diagnosis can bring high levels of stress and anxiety.
A cancer diagnosis can bring high levels of stress and anxiety.

Patients with Philadelphia-negative myeloproliferative neoplasms (MPNs) may be highly susceptible to experiencing anxiety and/or depression and, therefore, should be routinely assessed for psychological distress, study results published in Clinical Epidemiologyhave shown.

Philadelphia-negative MPNs include 3 diseases: essential thrombocythemia (ET), polycythemia vera (PV), myelofibrosis (MF), and in some cases, unclassifiable MPN (MPN-U). Some patients with MPN can achieve a cure after bone marrow transplantation; however, few are eligible for this treatment. As a result, MPNs are largely chronic diseases but in many cases develop into acute myeloid leukemia.

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Patients with one of these diseases are often coping with high symptom burden, financial difficulties, limited functioning in daily life, and a reduced lifespan. These issues can be challenging and can cause psychological distress (defined in this study as anxiety and/or depression). However, data on the prevalence of distress in this patient population is scarce.

Therefore, researchers in Denmark sought to determine the prevalence and severity of anxiety and depression in patients with MPNs with the MPNhealthSurvey, a nationwide, population-based, cross-sectional survey of health-related quality of life (HRQOL). Using the Hospital Anxiety and Depression Scale (HADS), the researchers sought to determine prevalence and severity of anxiety and depression in patients with ET, PV, MPN, or MPN-U, as well as the associations with demographic and lifestyle factors, disease factors, and health status. 

For this study, researchers invited a total of 2029 patients with ET, PV, MF, or MPN-U to complete the HADS. Results demonstrated a prevalence of anxiety, depression, or both in 21%, 12%, and 8%, respectively, of patients. 

Participants' HADS scores indicated odds for anxiety and depression were lower in middle-aged and elderly participants, never smokers, and those who engaged in hard training several times a week compared with younger participants, current and ex-smokers, and those who were sedentary or engaged in lower levels of physical activity, respectively. 

Odds for anxiety were lower in male patients vs female patients. Those with higher education levels also demonstrated lower odds for anxiety compared with participants with lower education levels. Odds for depression were higher in participants with greater comorbidities.

Greater financial difficulties were associated with higher odds for anxiety; higher total symptom burden and higher fatigue burden were strongly associated with higher odds for anxiety. Higher level of sexual problems, lower functional level, and lower global health/quality of life were also associated with higher odds for anxiety and depression.

Body mass index, alcohol intake, and comorbidity burden were not substantially associated with anxiety, and sex and educational level were not substantially associated with depression. Duration of disease was not substantially associated with anxiety or depression.

Based on these results, clinicians are advised to be more aware of the potential for anxiety and/or depression in patients with MPN. Regular assessment using diagnostic interview or the HADS can help identify those patients experiencing distress early. The researchers also suggest that clinicians stay alert not only to signs of psychological distress, but also to its related factors. Implementing lifestyle interventions, rehabilitation, and symptom reduction may be an essential part of treatment for many patients with MPN.

Reference

Brochmann N, Flachs EM, Christensen AI, et al. Anxiety and depression in patients with Philadelphia-negative myeloproliferative neoplasms: a nationwide population-based survey in DenmarkClin Epidemiol.2019;11:23-33.
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