Coping strategies in patients with acute myeloid leukemia

Abstract

Patients diagnosed with acute myeloid leukemia (AML) face sudden-onset life-threatening disease that requires intensive treatments. Although their early disease trajectory is characterized by significant, toxic side effects, there is limited data describing coping strategies among patients with AML and how these inform patient-reported outcomes. We used cross-sectional secondary data analyses to describe coping in 160 patients with newly diagnosed high-risk AML. We used the Brief COPE, Hospital Anxiety and Depression Scale, PTSD Checklist-Civilian Version, and Functional Assessment of Cancer Therapy-Leukemia at time of AML diagnosis to measure coping strategies, psychological distress and quality of life (QOL), respectively. We used the median split method for distribution of coping domains, and multivariate regression models to assess the relationship between coping and patient-reported outcomes. Participants (median age=64.4 years) were mostly non-Hispanic White (86.3%), male (60.0%), and married (73.8%). Most (51.9%) had high utilization of approach-oriented coping strategies whereas 38.8% had high utilization of avoidant coping strategies. At time of diagnosis, use of approach-oriented coping was associated with less psychological distress (anxiety: β=-0.262, p=0.002; depression symptoms β=-0.311, p<0.001; PTSD symptoms: β=-0.596, p=0.006) and better QOL (β=1.491, p=0.003). Use of avoidant coping was associated with more psychological distress (anxiety: β=0.884, p<0.001; depression symptoms: β=0.697, p<0.001; PTSD symptoms: β=3.048, p<0.001) and worse QOL (β=-5.696, p<0.001). Patients with high-risk AML utilize various approach-oriented and avoidant coping strategies at time of diagnosis. Use of approach-oriented coping strategies was associated with less psychological distress and better QOL, suggesting a possible target for supportive oncology interventions.

Relationship Between Longitudinal Coping Strategies and Outcomes in Patients With Acute Myeloid Leukemia

“…33 To reduce the questionnaire burden for participants, we followed a similar approach used in previous studies, which considered the following 7 coping strategies: emotional support, self-blame, positive reframing, active coping, acceptance, denial, and behavioral disengagement. 17,33,34 Scores for each scale range from 2 to 8, with higher scores indicating greater use of a particular coping strategy. We grouped coping strategies into 2 higher-order domains based on prior literature using an aggregate of individual domain scores: approachoriented coping (ie, use of emotional support, active coping, positive reframing, acceptance) or avoidant coping (ie, self-blame, denial, behavioral disengagement).…”

“…We grouped coping strategies into 2 higher-order domains based on prior literature using an aggregate of individual domain scores: approachoriented coping (ie, use of emotional support, active coping, positive reframing, acceptance) or avoidant coping (ie, self-blame, denial, behavioral disengagement). [16][17][18]34 We defined "last reported coping strategy used" for either approach-oriented or avoidant coping as the last coping strategy on record (ie, at baseline or at weeks 2, 4, 12, or 24 after diagnosis) for a given patient in the dataset.…”

“…We used the 17-item Post-Traumatic Stress Disorder Checklist-Civilian Version to evaluate posttraumatic stress disorder (PTSD) symptoms. The 17 items on the checklist assess 3 categories of PTSD symptoms as follows: intrusion (items 1-5), avoidance (items 6-12), and hypervigilance (items [13][14][15][16][17]. The PTSD symptom severity score was obtained by summing the scores from each of the 17 items.…”

“…14,15 Coping flexibility (ie, adjusting and changing coping strategies to enhance desirable outcomes based on a given context) relies on the availability and utilization of a variety of coping strategies. 16 Although we know that patients with newly diagnosed AML use a variety of coping strategies both in the avoidant and approach-oriented coping domains, 17 there are limited data from this population characterizing longitudinal patterns of coping and investigating whether longitudinal changes in coping are associated with clinical outcomes and healthcare utilization.…”

Early Palliative Care in Acute Myeloid Leukemia

“…Once more, the use of approach-oriented coping was associated with fewer PTSD symptoms at 1 month. The study is relevant because it emphasizes the critical need to screen patients with AML for PTSD symptoms by demonstrating, for the first time, that PTSD rates in this setting are significantly higher than those reported in other hematologic and cancer patients [69,70].…”