Correlates of anxiety and depression in chronic lymphocytic leukemia (CLL) survivors.

Abstract

153 Background: CLL is an indolent lymphoma effecting aging populations. Early stage patients are assigned to active surveillance and only 10% of patients require treatment at diagnosis. Active surveillance for CLL may increase susceptibility to anxiety and depression, resulting in enhanced comorbidities and reduced quality of life. However, little is known about the prevalence and risk factors of anxiety and depression in CLL. Methods: 125 CLL patients that were treatment naïve (n = 86) or previously chemotherapy-treated (n = 39) completed anxiety and depression questionnaires (State Trait Anxiety Index (STAI) and Center for Epidemiologic Studies Depression (CES-D)). Multivariable linear regression was used to examine associations with STAI/CES-D score. Logistic regression was used to examine clinically meaningful anxiety and depression, using validated cut points of 40 for the STAI and 16 (or on antidepressants) for the CES-D. All models included treatment status (treatment naïve vs. treated), age, gender, ECOG grade, time since diagnosis, education, & disease stage. Results: Patients had a median age of 65, were mostly male (60.8%), Caucasian (96%), well educated (55% ≥ college), and had low stage CLL (66% stage 0) and good performance status (67% ECOG 0). 20 and 24% of patients had clinically meaningful anxiety or depression (11% had both). Treatment and time since diagnosis were not associated with anxiety or depression. Older age was associated with better STAI and CES-D scores (STAI β = -0.34 (95%CI -0.52, -0.17) CES-D β = -0.27 (95%CI -0.42, -0.12)), and each 1 year increase in age was associated with a 9% decrease in odds of anxiety and a 7% decrease in odds of depression (OR 0.91(95%CI 0.86, 0.96) OR 0.93 (95%CI 0.88, 0.98) respectively). An ECOG grade of 3 or 4 was a significant predictor of increased depression risk (OR 2.84 (95%CI 1.03, 7.82)) and worse CES-D scores (β = 4.69 (95%CI 8.09, 1.29)) but not of anxiety. Conclusions: Anxiety and depression are common among CLL patients. Poor performance status was associated with more depression while older age was associated with less anxiety and depression. Future studies should investigate potential interventions for anxiety and depression in younger CLL patients.

International validation of the EORTC QLQ‐CLL17 questionnaire for assessment of health‐related quality of life for patients with chronic lymphocytic leukaemia

“…The finding that both patients that are actively treated and those who first follow a watchful waiting approach until their disease progresses experience symptom burden, worries and anxiety from the disease itself is in line with the literature 2,14,48,49 . HRQoL is therefore critically important for the entire CLL population and should be thought of as a major goal of treatment and disease management as also highlighted by an international expert commission in haematological malignancies 21 .…”

“…The finding that both patients that are actively treated and those who first follow a watchful waiting approach until their disease progresses experience symptom burden, worries and anxiety from the disease itself is in line with the literature. 2,14,48,49 HRQoL is therefore critically important for the entire CLL population and should be thought of as a major goal of treatment and disease management as also highlighted by an international expert commission in haematological malignancies. 21 As the QLQ-CLL17 taps into disease-related, and treatment-related CLL symptoms, using the questionnaire in daily clinical practice can help clinicians identify specific CLL symptoms that require further examination and discussion with the patient.…”

Health-related quality of life and economic burden of chronic lymphocytic leukemia in the era of novel targeted agents

“…The initial screening retrieved 9426 citations, and following the data-extraction process, 12 primary studies (reported in 17 publications) were included in the HRQoL burden review (Figure 1). The 12 studies differed in terms of design, study populations, and the instruments used to measure HRQoL burden (Table 1) [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] . The majority of studies were conducted in the United States (n ¼ 6) and Europe (n ¼ 3); study populations included both treated and untreated patients, as well as those with R/R disease.…”

“…Across studies included in the review, the mean age of patients with CLL ranged from 59-70 years [15][16][17][18]21,23,[26][27][28][29] and the proportion of male patients varied from 46% to 70% 15,17,21,23,[26][27][28] . Four primary studies investigated the impact of gender 15,16,21,26 and four investigated the impact of age 15,16,21,24 on HRQoL in patients with CLL.…”