Anxiety and depression associated with tyrosine kinase inhibitor discontinuation in patients with chronic myeloid leukemia

Sogawa, Rintaro; Kimura, Sakiko; Yakabe, R.; Mizokami, Yasuhito; Tasaki, Masanobu; Sueoka‐Aragane, Naoko; Narisawa, Yutaka; Kimura, Shinya

doi:10.1007/s10147-018-1275-6

Cited by 21 publications

(17 citation statements)

References 25 publications

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“…There was also an increase in the reported severity of the impact of the emotional side effects of anxiety, feeling distressed and feeling upset in this phase, compared with before discontinuation of treatment. These results echo those of Sogawa et al [49], who reported significantly higher anxiety and depression on the Hospital Anxiety and Depression Scale (HADS), at reintroduction of TKI than at the point of TKI discontinuation.…”

Section: Psychological and Emotional Impact Of Tfrsupporting

confidence: 88%

Treatment-free remission in chronic myeloid leukemia: the patient perspective and areas of unmet needs

et al. 2020

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In CML, treatment-free remission (TFR) refers to having a stable deep molecular response without the need for ongoing tyrosine kinase inhibitor treatment. Whilst recommendations exist about the technical management of stopping and restarting therapy, much is still unknown about the experiences of those considering and undertaking TFR. This study sought to obtain the patient perspective, identify areas of unmet needs and create recommendations for improvements. Fifty-six percent of patients reported fear or anxiety during treatment discontinuation, whereas only 7% of patients were asked if they needed psychological support during this period. Where patients re-initiated treatment; 59% felt scared or anxious, and 56% felt depressed. Twenty-six percent of re-initiated patients received psychological and/or emotional support at this time. Sixty percent of patients experienced withdrawal symptoms whilst discontinuing treatment, however, 40% of patients who experienced withdrawal symptoms reported that they were not fully supported by their doctor in managing all the symptoms. Healthcare professionals should further consider how they monitor the psychological well-being of patients who are discontinuing or re-initiating treatment, and review what support is offered in response to identified concerns. Surveillance of withdrawal symptoms should be a priority during treatment discontinuation, along with how healthcare professionals assist in the management of these.

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Section: Psychological and Emotional Impact Of Tfrsupporting

confidence: 88%

Treatment-free remission in chronic myeloid leukemia: the patient perspective and areas of unmet needs

et al. 2020

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“…As in other studies, the potential negative consequences of TKI treatment discontinuation were primarily related to emotional stress producing feelings of uncertainty, anxiety, and regret that may be brought about by treatment discontinuation or its failure [19,20,22,24,25]. Indeed, relapse and the subsequent resumption of TKI treatment have been found to increase anxiety and depression [30]. In view of the still considerable rate of relapse, these kind of concerns are also a major reason for certain patients not to discontinue TKI treatment.…”

Section: Discussionmentioning

confidence: 84%

Tyrosine kinase inhibitor treatment discontinuation in chronic myeloid leukemia: patient views

Tromp

Timmers

Koningen

et al. 2020

Leukemia & Lymphoma

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Patients with chronic myeloid leukemia (CML) in deep molecular remission may discontinue tyrosine kinase inhibitor (TKI) treatment without relapse. The present study aims to gain insight into the views of CML patients on TKI treatment discontinuation and identify factors that are associated with their willingness to discontinue treatment. A cross-sectional study, among adult Dutch CML patients was conducted to assess willingness and their views on benefits of and concerns about discontinuation. A total of 185 patients participated of whom 76% were willing to discontinue TKI-treatment. Patients considered the absence of side effects the most important benefit whereas fear of disease recurrence was their most prominent concern. Adequate monitoring was the most important prerequisite for TKI-treatment discontinuation. However, ambiguity with respect to perquisites indicate that patients on long-term TKI treatment should be adequately informed both on the possibility to discontinue treatment and on its benefits, risks, and measures that address risks.

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“…However, caution is urged before adopting TFR as the sine plus ultra of CML treatment, in place of the more humble aim of at least MMR (and thus freedom from progression) without unacceptable side effects. Around 20% of otherwise eligible patients may not wish to stop treatment [16••, 56], and TKI cessation may raise levels of anxiety and depression [57]. Interestingly, a recent survey of over 1500 patients suggests that they are less concerned about TFR than haematologists, and regard other facets of the disease as of greater importance [58].…”

Section: Discussionmentioning

confidence: 99%

Tyrosine Kinase Inhibitor Therapy Discontinuation for Patients with Chronic Myeloid Leukaemia in Clinical Practice

Clark

2019

Curr Hematol Malig Rep

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Purpose In chronic myeloid leukaemia, tyrosine kinase inhibitor treatment is traditionally given continuously for life. However, these drugs produce excellent responses for many patients, and this is accompanied by survival that is close to normal. This has prompted studies of whether it is possible to stop treatment, thus achieving a treatment-free remission (TFR). Recent Findings Most TFR studies have focussed on abrupt cessation in patients with long-standing deep remissions, but recent data suggest that more gradual treatment de-escalation may improve TFR success, and that it may be possible to extend TFR attempts to patients who are in stable major molecular response but not necessarily MR4. Summary Further data are badly needed on TFR for patients whose remission is less than stable MR4 and on the importance of prior interferon-alpha treatment. Funding TFR trials in a disease with such an excellent outlook is an increasing challenge.

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Anxiety and depression associated with tyrosine kinase inhibitor discontinuation in patients with chronic myeloid leukemia

Abstract: Stopping TKIs outside clinical trials is feasible if the guidelines for stopping are followed and an adequate monitoring system is available. Discontinuation of TKIs requires adequate management of anxiety and depression.

Cited by 21 publications

References 25 publications

Treatment-free remission in chronic myeloid leukemia: the patient perspective and areas of unmet needs

Treatment-free remission in chronic myeloid leukemia: the patient perspective and areas of unmet needs

Tyrosine kinase inhibitor treatment discontinuation in chronic myeloid leukemia: patient views

Tyrosine Kinase Inhibitor Therapy Discontinuation for Patients with Chronic Myeloid Leukaemia in Clinical Practice

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