پیش بینی پریشانی روانی در بیماران مبتلا به لوسمی و لنفوم

This study examines the relationship between coping style, quality of life (QOL) and psychological distress in a sample of patients with leukaemia and lymphoma. Fifty-one consecutive in-patients, day cases and haematology out-patient attenders entered the study and completed a 10-item self-report questionnaire, the Hospital Anxiety and Depression Scale (HADS), the Mental Adjustment to Cancer Scale (MACS) and the Schedule for the Evaluation of Individual Quality of Life (SEIQOL). Fifty-one percent of patients reached caseness for moderate distress. Fourteen percent of patients reached caseness for severe distress. Twenty-seven percent of patients were identified as having adjusted poorly to their diagnosis having low scores on the Fighting Spirit subscale of the MAC and high scores on the Hopeless/Helpless subscale. There was a significant association between patients who scored highly on the HADS and dissatisfaction with the information provided. Use of a logistic regression model showed that those patients most likely to be suffering from severe psychological distress were those with a worse coping style, measured by MAC. The clinical implications of these findings are discussed.

Patients undergoing treatment for haematological malignancies suffer from high levels of undetected anxiety and depression [1]. In long-term survivors of leukaemia and lymphomas, high levels of anxiety persist for long periods after chemotherapy when exposed to a reminder of their treatment [2]. Increasingly, very intensive treatments are being proposed especially allergenic or autologous bone marrow transplant (BMT) in young adults. Psychological adaptation to such treatments is highly individual, but a proportion of patients will experience a marked deterioration in quality of life (QOL) and/or will develop clinical depression [3]. Around 35% of patients, during the induction and consolidation phase of treatment, have been found to have high levels of anxiety and depression [4]. In nonhaematological malignancy between 25% and 33% of cancer patients develop an anxiety disorder or major depression [5], while some studies cite rates of depression at around 50% [6]. The development of depression among cancer patients has been shown to have clear effects on increased amount of pain reported [7] and increases the likelihood of dropping out of treatment [8]. In addition, an association between depression, altered immunity and thus lowered survival rates has been suggested by a number of studies [9] and [10]. Colon et al. [11] found that depressed mood before bone marrow transplantation in patients with acute leukaemia was one variable that was associated with poor survival outcome. Despite depression being a relatively common and clinically important comorbid illness within this patient group little attention has been paid to those factors that may predict its onset. It would be of value to identify those patients most at risk of developing depression and anxiety so that appropriate interventions can be targeted upon them. Therefore, the present study aimed to identify patient and treatment factors most strongly associated with severe psychological distress with a view to developing preventative therapeutic interventions for those most at risk.