Department of Psychiatry, Brigham and Women's Hospital, Boston, MA.
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA.
Blood Adv. 2022 Apr 12;6(7):2435-2442. doi: 10.1182/bloodadvances.2021005845.
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, limited data are available 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. The Brief COPE, Hospital Anxiety and Depression Scale, Post-Traumatic Stress Disorder Checklist-Civilian Version, and Functional Assessment of Cancer Therapy-Leukemia were used at time of AML diagnosis to measure coping strategies, psychological distress, and quality of life (QOL), respectively. The median split method for distribution of coping domains and multivariate regression models were used 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 = .002; depression symptoms, β = -0.311, P < .001; and posttraumatic distress disorder symptoms, β = -0.596, P = .006) and better QOL (β = 1.491, P = .003). Use of avoidant coping was associated with more psychological distress (anxiety, β = 0.884, P < .001; depression symptoms, β = 0.697, P < .001; and posttraumatic distress disorder symptoms, β = 3.048, P < .001) and worse QOL (β = -5.696, P < .001). Patients with high-risk AML use 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.
患者被诊断患有急性髓性白血病 (AML)，这是一种突发的危及生命的疾病，需要进行强化治疗。尽管他们的早期疾病轨迹具有显著的毒性副作用，但可用的数据有限，无法描述 AML 患者的应对策略以及这些策略如何影响患者报告的结果。我们使用横断面二次数据分析来描述 160 例新诊断为高危 AML 的患者的应对方式。在 AML 诊断时，使用Brief COPE、医院焦虑和抑郁量表、创伤后应激障碍清单-平民版和癌症治疗-白血病功能评估量表分别测量应对策略、心理困扰和生活质量 (QOL)。使用分布的中位数分割法和多变量回归模型来评估应对与患者报告结果之间的关系。参与者（中位年龄，64.4 岁）主要是非西班牙裔白人（86.3%）、男性（60.0%）和已婚（73.8%）。大多数人（51.9%）采用了积极的应对策略，而 38.8%的人采用了回避的应对策略。在诊断时，采用积极的应对策略与较少的心理困扰（焦虑，β=-0.262，P=.002；抑郁症状，β=-0.311，P<.001；和创伤后应激障碍症状，β=-0.596，P=.006）和更好的 QOL（β=1.491，P=.003）相关。采用回避的应对策略与更多的心理困扰（焦虑，β=0.884，P<.001；抑郁症状，β=0.697，P<.001；和创伤后应激障碍症状，β=3.048，P<.001）和更差的 QOL（β=-5.696，P<.001）相关。患有高危 AML 的患者在诊断时会使用各种积极的和回避的应对策略。采用积极的应对策略与较少的心理困扰和更好的 QOL 相关，这表明支持肿瘤学干预的一个可能目标。
