The psychological distress patients feel when diagnosed with acute leukemia is often devastating and overwhelming. For those already struggling with depression, anxiety or other psychiatric symptoms, it is hypothesized that the addition of a diagnosis of acute leukemia would exacerbate the psychiatric symptoms already present. Anecdotal case reports have shown that upon being diagnosed with cancer, typically the first hours to first several days, patients are overwhelmed and unable to process all of the information being given to them by the oncology physician/team. In the case of acute leukemia patients, there is the additional layer of distress due to an urgency to start treatment within days of diagnosis. In this study, psychological data was prospectively collected on 40 patients newly diagnosed with acute leukemia. Each patient was assessed for pre-existing psychiatric diagnosis based on DSM-IV criteria. Patients were placed into one of two groups: psychiatric diagnosis prior to acute leukemia (n=22) or no psychiatric diagnosis prior to acute leukemia (n=18). Each patient completed the Brief Symptom Inventory -18 (BSI-18) at Days 1, 7 and 21 during their induction chemotherapy for acute leukemia. There were no significant differences in gender, age, or disease (AML vs. ALL) between the two groups. The BSI-18 has a Global Stress Index (GSI) score and subscale scores, including Anxiety and Depression. Patients with psychiatric diagnoses prior to having acute leukemia had significantly higher GSI scores at Days 1 (p=.005) and 7 (p=.02) as compared to those patients who did not have a psychiatric diagnosis. This trend was the same when looking at the Anxiety subscale which also found a significant difference between groups, with the patients having psychiatric diagnoses reporting significantly more anxiety at Days 1 (p=.003) and 7 (p=.02). With regard to symptoms of Depression, patients with pre-existing psychiatric diagnoses reported significantly more symptoms of depression at Day 7 (p=.009) as compared to those patients without a psychiatric diagnosis. By Day 21, there was no significant difference in GSI, Anxiety or Depression between groups. During the induction chemotherapy, all patients were evaluated by the program's Health Psychologist within 72 hours of admission to the leukemia unit and psychological follow-up during their chemotherapy treatment. All 40 patients remained hospitalized from Day 1 of chemotherapy until count recovery. The data indicates that those patients with pre-existing psychiatric diagnoses have significantly more difficulty coping during the first week of their induction chemotherapy for acute leukemia. However, by the time patients have been in treatment for 21 days, all patients appear to be coping moderately well with no objective evidence of clinical depression or anxiety. One may conclude that although psychosocial factors impact a patient's ability to cope with a major stressor, such as being diagnosed with acute leukemia, these differences are most apparent immediately following diagnosis. It appears that in time, both groups of patients appear to be able to deal with the emotional distress related to the diagnosis of acute leukemia. Additionally, it would appear that patients with a history of psychiatric diagnoses might require more psychosocial support during the early days of treatment. Further research is needed to identify what factors (time, education, family support, health psychology services, etc…) are most useful in assisting these psychiatric patients with their psychological distress.
No relevant conflicts of interest to declare.
Asterisk with author names denotes non-ASH members.