Department of Psychiatry, Brigham and Women's Hospital.
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, and.
J Natl Compr Canc Netw. 2022 Oct;20(10):1116-1123. doi: 10.6004/jnccn.2022.7045.
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.
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.
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).
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.
急性髓系白血病 (AML) 患者面临着危及生命的急性疾病，经历着巨大的身体和心理症状。然而，目前尚无数据描述 AML 患者如何长期应对疾病，以及纵向应对与结局之间的关系。
我们对参加支持性护理干预试验的 160 例高危 AML 患者的纵向数据进行了二次分析，以描述疾病过程中纵向应对策略的变化。我们使用 Brief COPE 问卷、医院焦虑和抑郁量表、创伤后应激障碍 (PTSD) 清单-平民版和癌症治疗-白血病功能评估量表来测量基线和诊断后 2、4、12 和 24 周时的应对策略、心理困扰和生活质量 (QoL)。电子健康记录用于评估医疗保健的使用情况和生命末期 (EoL) 结局，多变量分析用于评估应对与结局之间的关系。
采用积极应对策略的纵向利用与较少的困扰（焦虑：β，-0.18；P <.001；抑郁症状：β，-0.42；P <.001；PTSD 症状：β，-0.60；P <.001）和更好的 QoL（β，2.00；P <.001）显著相关。采用回避应对策略的纵向利用与更大的困扰（焦虑：β，0.64；抑郁症状：β，0.54；PTSD 症状：β，2.13；P <.001 均为）和较差的 QoL（β，-4.27；P <.001）显著相关。尽管积极和回避应对策略的使用与生命最后 30 天内的住院、化疗管理或临终关怀使用无关，但积极应对策略与 ICU 入院的可能性较低相关（比值比，0.92；P =.049）。
采用积极应对策略的纵向使用与较少的心理困扰、更好的 QoL 和较低的 ICU 入院率相关，这表明支持性肿瘤学干预的一个可能目标。应对策略并未影响生命末期结局，需要进一步研究阐明哪些患者因素会影响生命末期决策。
