Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts.
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.
Cancer. 2021 Jul 15;127(14):2500-2506. doi: 10.1002/cncr.33524. Epub 2021 Mar 25.
Patients with acute myeloid leukemia (AML) receiving intensive chemotherapy face a life-threatening illness, isolating hospitalization, and substantial physical and psychological symptoms. However, data are limited regarding risk factors of posttraumatic stress disorder (PTSD) symptoms in this population.
The authors conducted a secondary analysis of data from 160 patients with high-risk AML who were enrolled in a supportive care trial. The PTSD Checklist-Civilian Version was used to assess PTSD symptoms at 1 month after AML diagnosis. The Brief COPE and the Functional Assessment of Cancer Therapy-Leukemia were to assess coping and quality of life (QOL), respectively. In addition, multivariate regression models were constructed to assess the relation between PTSD symptoms and baseline sociodemographic factors, coping, and QOL.
Twenty-eight percent of patients reported PTSD symptoms, describing high rates of intrusion, avoidance, and hypervigiliance. Baseline sociodemographic factors significantly associated with PTSD symptoms were age (B = -0.26; P = .002), race (B = -8.78; P = .004), and postgraduate education (B = -6.30; P = .029). Higher baseline QOL (B = -0.37; P ≤ .001) and less decline in QOL during hospitalization (B = -0.05; P = .224) were associated with fewer PTSD symptoms. Approach-oriented coping (B = -0.92; P = .001) was associated with fewer PTSD symptoms, whereas avoidant coping (B = 2.42; P ≤ .001) was associated with higher PTSD symptoms.
A substantial proportion of patients with AML report clinically significant PTSD symptoms 1 month after initiating intensive chemotherapy. Patients' baseline QOL, coping strategies, and extent of QOL decline during hospitalization emerge as important risk factors for PTSD, underscoring the need for supportive oncology interventions to reduce the risk of PTSD in this population.
接受强化化疗的急性髓系白血病（AML）患者面临危及生命的疾病、孤立的住院治疗以及大量的身体和心理症状。然而，关于该人群创伤后应激障碍（PTSD）症状的危险因素的数据有限。
作者对参加支持性护理试验的 160 名高危 AML 患者的数据进行了二次分析。使用 PTSD 清单-平民版在 AML 诊断后 1 个月评估 PTSD 症状。简要应对量表和癌症治疗-白血病功能评估量表分别用于评估应对和生活质量（QOL）。此外，构建了多变量回归模型来评估 PTSD 症状与基线社会人口统计学因素、应对和 QOL 之间的关系。
28%的患者报告有 PTSD 症状，描述了高发生率的闯入、回避和警觉。与 PTSD 症状显著相关的基线社会人口统计学因素是年龄（B = -0.26；P =.002）、种族（B = -8.78；P =.004）和研究生教育（B = -6.30；P =.029）。较高的基线 QOL（B = -0.37；P ≤.001）和住院期间 QOL 下降较少（B = -0.05；P =.224）与 PTSD 症状较少有关。面向方法的应对（B = -0.92；P =.001）与 PTSD 症状较少有关，而回避应对（B = 2.42；P ≤.001）与 PTSD 症状较多有关。
相当一部分 AML 患者在开始强化化疗后 1 个月报告有临床意义的 PTSD 症状。患者的基线 QOL、应对策略和住院期间 QOL 下降程度是 PTSD 的重要危险因素，这强调了在该人群中需要支持性肿瘤学干预措施来降低 PTSD 的风险。
