Quality of Life in Elderly Patients with Essential Thrombocythemia.

Based on recent diagnostic criteria (WHO 2008), the incidence of Essential Thrombocythemia (ET) in Italy is estimated to be around 1500 cases/year with a prevalence of at least of 30000 cases. Median age at diagnosis is 60 years. ET patients receive a median of four visits/year from hematologists who are increasingly requested to take care of both patient survival and QoL Though increased awareness and new therapeutic approaches have improved patients' overall survival, information on QoL of life and its correlates in ET patients is lacking.

We evaluated physical and mental QoL and its correlates (age, gender, personal attitude, disease duration, PLT count, and treatment) in a cross-sectional, multicenter, national cross-sectional study performed in 30 italian centers in elderly patients (age > 60 years) with Essential Thrombocythemia (ET). The survey was self-administered and completed anonymously in all ET patients sequentially undergoing a hematological visit within each participating center in a 3-week time span. The survey consisted of demographic, social, personal and disease-related items and the SF-12 short form QoL questionnaire. In order to distinguish attitude clusters within the sample we performed a factorial analysis based on 6 item scores related to personality within the survey.

Four hundred and ninety-one patients (215 M, 276 F) of mean age 69 ± 6 years participated and 395 completed a sufficient number of items to be included in the cluster analysis. PLT count was 474,814 ± 169,776. Cytoreductive therapy was prescribed in 431 patients and 230 patients were taking antiplatelet therapy. Six items formed an “attitude domain” (Cronbach alph standardized coeff. = 0,89) so that 4 clusters of patients were distinguished (A= very pessimistic, B= pessimistic, C= optimistic, D= very optimistic). Clusters were comparable for gender and PLT count. Cluster A included older patients compared to Cluster D (p<0.0001). Patients in cluster A were much more disturbed by medication (p<0.0001,) including side effects (p=0.001), compared to the more optimistic groups, but they also had a higher number of comorbidities (p=0.003). Cluster D had less frequent hematological visits. There were no significant differences in fear of complications (thrombotic events, hemorrhages). The SF-12 questionnaire was fully completed by 342 patients. Physical QoL and Mental QoL were poor: median 41 (IQ range 34-49) and 45 (IQ range 36-53), respectively. Sexual activity was not influenced by treatment. Physical Qol correlated with mental QoL (r=0.349, p<0.0001), attitude clusters (r=0.561, p<0.0001) and was inversely correlated with age (age (r=-0.281, p<0.0001), Charlson Comorbidity Index (r=-0.478, p < 0.0001), disturbances related to medication (r=-0.259, p<0.0001) and geographical area (p<0.0001). Males had a better physical QoL (median 48 vs 41, p=0.001. Mental QoL correlated with attitude clusters (r=0.605, p<0.0001) was inversely correlated with age (r=-0.120, P=0.020), Charlson Comorbidity Index (r=-0.279, p<0.0001) and disturbances related to medication (r=-0.340, p<0.0001). At multivariate analysis factors predicting physical Qol were attitude, gender and Charlson Comorbidity index (Table 1). Mental QoL was independently predicted by attitude and disturbances related to medication (Table 2).

Physical and mental Qol in ET is surprisingly poor. Elderly age and comorbidities contribute to the perception of well-being but personality (optimism) plays a major role in determining QoL in patients with ET.

No relevant conflicts of interest to declare.