Comparative Assessment of Significant Psychological Distress In Patients with Malignant and Non-Malignant Hematologic Disorders

Several measurement tools for distress have been extensively evaluated in patients with solid tumor malignancies and are useful in various stages of treatment, but none have been consistently incorporated into clinical care for hematology patients. The degree of distress in patients with hematologic disease, both malignant and non-malignant is under-investigated, and comparisons of stress levels of patients with malignant and non-malignant blood disorders are infrequent.

To asses and compare distress in patients with malignant and non-malignant hematological disorders at a multidisciplinary community-based hematology/oncology clinic.

Consecutive adult malignant and non-malignant hematology patients (n=617) seen at the Gundersen Lutheran Center for Cancer and Blood Disorders were prospectively enrolled over a 6 month period. Patients were excluded for incomplete surveys. Study patients completed a prospective survey that included the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT; scale of 0–10) and the modified NCCN problem list at the first clinic visit and all subsequent visits throughout the study period. All prospective surveys were completed prior to each clinic appointment. Additional demographics including diagnosis and disease related information were collected by chart review. A distress score ≥ 5 was used an indicator of distress.

A total of 572 patients met study criteria (mean age 62.4±17.4 yrs; 49% men; 56% non-malignant hematologic disorders). The mean DT stress number for the cohort was 3.4±2.7, with 36% rating distress ≥5. Univariate logistic regression analysis revealed younger age (OR:1.33, CI:1.20-1.47;p=0.001, per 10 year decrease in age), history of depression and/or anxiety (OR:3.14, CI:2.20-4.48;p=0.001), female gender (OR:2.23, CI:1.62-3.27;p=0.001), non-malignant disease state (OR:1.51, CI:1.06-2.14;p=0.022) and unmarried (OR:1.70, CI:1.18-2.46;p=0.005) were all associated with a distress score ≥5. The timing of patients’ first visit to hematology clinic was also associated with a distress score ≥5, with patients filling out the DT and problems list within 30 days of their first hematology visit more likely to rate distress ≥5 (OR:1.92, CI:1.21-3.04; p=0.008 compared to patients more than 1 year). All but non-malignant disease state remained associated with a distress score ≥5 in a multivariate analysis (Table 1). Further analysis for the subgroup of disease state (non-malignant vs malignant) revealed that subjects with non-malignant diagnoses were younger (61.1 vs 64.1 yrs; p=0.040), largely female (60% vs 40%; p=0.001), had greater history of depression and/or anxiety (47% vs 38%; p=0.035) and less likely to be married (66% vs 75%; p=0.013).

Distress levels of >5 on the DT were significantly more likely to occur in patients who were seen within the first 30 day of presentation, women, younger patients, those with previous depression/anxiety, and those who are unmarried. On multivariate analysis the diagnosis of malignant or non-malignant hematologic disorder did not predict DT levels >5. Based on these results, patients with malignant as well as non-malignant hematologic disorders with these risk factors should be considered for distress screening and management.

No relevant conflicts of interest to declare.