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

Abstract

Background: Patients with acute myeloid leukemia (AML) face an abrupt life-threatening illness and experience immense physical and psychological symptoms. However, no data describe how patients with AML cope longitudinally with their illness or the relationship between longitudinal coping and outcomes. Methods: We conducted a secondary analysis of longitudinal data from 160 patients with high-risk AML enrolled in a supportive care intervention trial to describe coping strategies longitudinally across the illness course. We used the Brief COPE questionnaire, the Hospital Anxiety and Depression Scale, the Post-Traumatic Stress Disorder (PTSD) Checklist-Civilian Version, and the Functional Assessment of Cancer Therapy-Leukemia to measure coping strategies, psychological distress, and quality of life (QoL) at baseline and at weeks 2, 4, 12, and 24 after diagnosis. Electronic health records were used to assess healthcare utilization and end-of-life (EoL) outcomes, and multivariate analyses were used to assess the relationship between coping and outcomes. Results: Longitudinal utilization of approach-oriented coping strategies was significantly associated with less distress (anxiety: β, –0.18; P<.001; depression symptoms: β, –0.42; P<.001; PTSD symptoms: β, –0.60; P<.001) and better QoL (β, 2.00; P<.001). Longitudinal utilization of avoidant coping strategies was significantly associated with greater distress (anxiety: β, 0.64; depression symptoms: β, 0.54; PTSD symptoms: β, 2.13; P<.001 for all) and worse QoL (β, –4.27; P<.001). Although the use of approach-oriented and avoidant coping strategies was not significantly associated with hospitalization, chemotherapy administration, or hospice use in the last 30 days of life, approach-oriented coping was associated with lower odds of ICU admissions (odds ratio, 0.92; P=.049). Conclusions: Longitudinal use of approach-oriented coping strategies was associated with less psychological distress, better QoL, and a lower likelihood of ICU admission, suggesting a possible target for supportive oncology interventions. Coping strategies did not impact EoL outcomes, and further research is needed to elucidate which patient factors impact EoL decision-making.

Coping in patients with hematologic malignancies undergoing hematopoietic cell transplantation

“…We calculated descriptive statistics, including means or medians for continuous variables and proportions for categorical variables. As in previous studies, 7 , 8 , 11 , 12 , 13 we used the median split method to dichotomize use of coping strategies in our sample, because there are no validated Brief-COPE cutoffs for low or high coping. We calculated the median scores for each of the 7 coping domains, then described the proportion of patients with a score greater than the median as “high utilizers” for each coping strategy.…”

“…We similarly used the median spit method to identify high utilizers of the composite variables for approach-oriented and avoidant coping. 11 , 12 Given concomitant use of approach-oriented and avoidant coping strategies, we created a categorical variable to describe overall coping. From the dichotomous variables of high use of approach-oriented and avoidant coping, we classified coping as “high use, approach-oriented only,” “high use, avoidant only,” “high use, approach and avoidant,” and “high use, neither.”…”

“… 10 In patients with advanced solid malignancies and acute myeloid leukemia, use of approach-oriented coping is associated with improved QOL and decreased symptoms of depression, anxiety, and PTSD, whereas avoidant coping is inversely correlated with these outcomes. 11 , 12 Furthermore, approach-oriented coping moderates the effect of supportive care interventions on clinical outcomes such as QOL. 7 , 13 Importantly, integrated specialty palliative care in patients with acute myeloid leukemia preserves approach-oriented coping and decreases avoidant coping, suggesting that coping strategies in patients with hematologic malignancy are modifiable.…”

Coping with stress styles and the level of perceived stress in hematopoietic cell transplant patients

“…Similarly, there are very limited data on the impact of coping styles on outcomes in non‐transplanted patients with both hematological and non‐hematological malignancies. Amonoo et al 18 . showed that approach‐oriented coping is associated with less distress and better quality of life, while avoidant coping ‐ with more distress and worse quality of life.…”

“…17 Similarly, there are very limited data on the impact of coping styles on outcomes in non-transplanted patients with both hematological and non-hematological malignancies. Amonoo et al 18 showed that approach-oriented coping is associated with less distress and better quality of life, while avoidant coping -with more distress and worse quality of life. Lehto et al 19 showed in patients with prostate cancer, that cognitive avoidance/ denial coping is a predictor of longer relapse-free survival, whereas hopelessness predicted a shorter relapse-free time.…”