Post-Traumatic Stress Disorder Prevalent in Patients with Acute Myeloid Leukemia

Patients with acute myeloid leukemia can experience post-traumatic stress disorder (PTSD) one month after receiving intensive chemotherapy and may benefit from supportive approach-oriented coping interventions, according to data published in Cancer.

Previously, there have been limited data regarding PTSD symptoms among patients with acute myeloid leukemia, which is a life-threatening illness. In an interview with CURE®, Dr. Hermioni L. Amonoo, lead author on this study and staff physician in the department of psychological oncology and palliative care at the Dana-Farber Cancer Institute, explained that this patient population experiences PTSD symptoms as a result of the life-threatening nature of the disease, intensive chemotherapy and isolating hospitalizations.

“Because of the nature of (acute myeloid leukemia) patients have to make a lot of big decisions very quickly,” Amonoo said. “We had an inkling from our clinical work that the sudden disruption of life routines that accompany the prolonged and isolating AML treatment hospitalization was traumatic – our hope was that this work will articulate some of this distress that patients’ experience

The authors analyzed 160 patients (median age, 64 years; 40% women) with high-risk acute myeloid leukemia who were enrolled in a supportive care trial. The PTSD Checklist-Civilian Version was used to assess PTSD symptoms one month after receiving a diagnosis of acute myeloid leukemia. In addition, the Brief COPE questionnaire assessed coping in these patients, and Functional Assessment of Cancer Therapy-Leukemia measured quality of life.

One month after diagnosis, 28% of patients in the study reported symptoms of PTSD including high rates of avoidance (100%), intrusion (92%), and hypervigilance (97%). In patients who did not experience clinically significant PTSD symptoms, 27% reported intrusion, 26% reported avoidance and 23% reported hypervigilance.

“It is our hope that (these results) really validate some of the psychological suffering our patients endure, mostly quietly, as part of their treatment from their AML. Sometimes, patients are not forthcoming about their emotional suffering in cancer treatment because “everyone” expects them to be strong to “fight” the cancer. They don’t want to appear ungrateful or disappoint their families and their loved ones,” Amonoo said. “Hopefully this work will encourage patients to speak up when they are having a traumatic reaction or symptoms as part of their cancer treatment….Also that they know that clinicians and researchers like myself are trying to really understand what these struggles are to hopefully develop interventions to help patients through them.”

Avoidant coping was associated with higher rates of PTSD symptoms, whereas approach- oriented coping, which was defined as “an adaptive coping strategy that focuses on promoting problem-solving, cognitive and behavioral efforts to resolve stressors and help patients manage various aspects of their illness,” was associated with fewer PTSD symptoms. Authors conclude that patients could benefit from supportive oncology interventions.

Factors that were significantly associated with higher rates of PTSD included age, White race and postgraduate education. A higher quality of life at the beginning of the study and less of a decline in quality of life during the treatment hospitalization were both associated with fewer PTSD symptoms. Patients with a lower quality of life at baseline and steeper decline in quality of life during the treatment hospitalization are especially at risk factor for PTSD symptoms. The study authors concluded that the AML treatment hospitalization likely represents a traumatic event.

“We also hope that this work would also educate oncology clinicians,” Amonoo noted, “And so this is also to let oncology clinicians know that screening patients with AML who are preparing for a treatment hospitalization for PTSD symptoms should be routine because it can impact their recovery trajectories.”

Limitations of this study include the population and the timing. The study only includes patients one month after diagnosis, so results do not account for later-onset PTSD symptoms or diagnosis.

“As part of the preparation and treatment planningfor patients with AML, patients shouldundergo apsychological health screen, if it doesn’t come up, we hope our work has empowered patients to ask for one especiallyif they have any historyoftrauma or other psychiatricillness. It maybe helpful for their oncology team to know about it so they can assemble the appropriate support and mental health resources they need before they even get hospitalized. From our study a large proportion of patients with AML in our study experienced some PTSD symptoms so it maybe common than we all think – patients should not feelembarrassed to bring these issues up to get help.”

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