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Anxiety, Depression Elevated in Patients with Histiocytic Neoplasms

January 25, 2025

February 2025

Lara C. Pullen, PhD

Lara C. Pullen, PhD, is a freelance medical writer in Chicago, Illinois.

While previous research has documented high levels of anxiety and depression in patients with cancer, mood disorders have not been systematically studied in patients with histiocytic neoplasms (HN). Research indicates that one in three patients with HN has anxiety and depression, which is stable over time and correlated with financial burden, symptom severity, and health-related quality of life (HRQoL). Anne S. Reiner, MPH, a senior research biostatistician at Memorial Sloan Kettering Cancer Center in New York, and colleagues published these findings from the first systemic study of anxiety and depression in patients with HN in Blood Advances.

The investigators designed their study to estimate rates of anxiety and depression in patients with HN and identify clinical features and patient-reported outcomes associated with mood disorders. They analyzed data from a heterogeneous, registry-based cross-sectional cohort of 215 patients with HN who enrolled between 2018 and 2023 and completed the Hospital Anxiety and Depression Scale (HADS) assessment at enrollment. The researchers used the registry to determine sex, age, disease features, length of undiagnosed histiocytosis, and length of diagnosed histiocytosis.

The team defined anxiety or depression as a score of 8+ and moderate or severe anxiety or depression as a score of 11+ on the HADS anxiety or depression subscales. At enrollment, 34% of patients met the criteria for anxiety, 13% met the criteria for moderate or severe anxiety, 28% of patients met the criteria for depression, and 15% met the criteria for moderate or severe depression. Twelve months later, the patients again completed the HADS, and 23% met the criteria for anxiety, 13% met the criteria for moderate or severe anxiety, 33% met the criteria for depression, and 14% met the criteria for moderate or severe depression, indicating that the results were stable over time.

“Anxiety and depression are so profoundly common in these diseases,” said senior investigator Eli L. Diamond, MD, a neuro-oncologist at Memorial Sloan Kettering, describing the rate as “staggeringly high.”

The rates of depression, but not anxiety, significantly differed across HN types. The researchers found that patients with Erdheim-Chester disease (ECD) had the highest rates of depression and were four times more likely to report moderate or severe depression than the totality of patients who had non-ECD HN. When the investigators used logistic regression to calculate the associations of variables with moderate or severe anxiety or depression, they found that older patients were less likely to meet the criteria for moderate or severe anxiety, and that an increase in one year of age was associated with a 3% decrease in the likelihood of meeting the criteria for moderate or severe anxiety. Financial burden, neurologic involvement, unemployment, and longer undiagnosed illness interval were significantly associated with increased risk of moderate or severe depression. The severity of pain, fatigue, and other HN-specific symptoms were correlated with an increased risk of moderate or severe anxiety and depression. Conversely, better general HRQoL and cognitive HRQoL were associated with a decreased risk of moderate or severe anxiety and depression.

Dr. Diamond suspects that because HN is a rare and often undiagnosed condition, the anxiety and depression may be due, in part, to unmanaged symptomology. He explained that it can take patients more than two years to receive a diagnosis, and that time is spent in uncontrolled inflammation. He added that the findings have made him “much more vigilant about screening for anxiety, depression, worry, or sadness.”

In their paper, the authors noted that a 2023 update of the American Society of Clinical Oncology guidelines recommended that all oncology patients be offered education about depression and anxiety.

“There is something therapeutic about being aware that this is something that patients struggle with,” Dr. Diamond said. “We’re trying to learn about the hardships endured by these patients.” 

Any conflicts of interest declared by the authors can be found in the original article.

Reference

Reiner AS, Alici Y, Correa DD, et al. Anxiety and depression in patients with histiocytic neoplasms and their associated clinical features [published online ahead of print, 2024 Dec. 3]. Blood Adv. doi: 10.1182/bloodadvances.2024014850.

 

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