Quality of Life In Adult De Novo Acute Leukemia Patients

Recent advances in the treatment of patients with acute leukemia have increased their long-term survival. However, the side effects of aggressive chemotherapy can have a significant impact on different dimensions of quality of life and various aspects of psychological well-being.

To assess depression, emotional well-being, and quality of life before and after induction treatment in de novo acute leukemia patients.

Current longitudinal-prospective study of adult de novo acute leukaemia patients, treated with induction chemotherapy at Hematology Department, UZ Ghent, Belgium. After enrollment, eligible patients are administered a number of self-report questionnaires, within five days after admission (pre-induction) and after completion of induction (pre-consolidation). We used the CES-D, the shortened version of the POMS, and the EORTC QLQ-C 30, to measure depression, emotional aspects of subjective well-being, and quality of life.

Twenty adult de novo acute leukemia patients were enrolled between 01/2009 and 06/2010. The median age was 43 years, 50% were male, 80% had AML (20% ALL), and their median years of education was 12 years. At baseline, patients had a low quality of life, and low role functioning, but also a high level of fatigue. Global health status related with social functioning (r=0.76, p=0.000), and role functioning related with fatigue (r=-0.58, p=0.008). A positive correlation was found between fatigue and nausea (r=0.55, p=0.011), but also pain (r=0.52, p=0.020). Diagnosis of de novo acute leukemia had a clear influence on different aspects of subjective well-being, in particular sixty-five percent of the patients had significant levels of depression (i.e. CES-D≥16) at baseline. Depressed patients had a significant lower global health status, emotional and social functioning (EORTC QLQ-C 30), but also less emotional vigor and more emotional tension (POMS) compared to non-depressed patients. Change in self-assessed measures was found in global health status (p=0.000), emotional functioning (p=0.000), and symptom scales fatigue (p=0.051) and nausea (p=0.005), all five scales of the POMS, and depression (all p<0.05). At follow-up, global health status related with four of the five functional scales, except for cognitive functioning (r=0.15, p=0.553), and also with one symptom scale fatigue (r=-0.64, p=0.003). Global health status related with the POMS vigor subscale (r=0.06, p=0.008) and CES-D depression (r=-0.54, p=0.018). Fatigue related with the POMS fatigue (r=0.62, p=0.005), vigor (r=-0.78, p=0.000), tension (r=0.62, p=0.004), and CES-D depression (r=0.72, p=0.000). At follow-up, thirty-five percent of patients had still significant levels of depression. Multiple regression analysis showed that the POMS subscale vigor had the highest predictive value of depression, of emotional well-being, and patient characteristics to explain quality of life at follow-up.

Adult de novo acute leukemia patients have at baseline low quality of life, high levels of depression, and a high negative emotional status of subjective well-being. Changes between two time points were observed across global health status, and some dimensions of quality of life, depression, and all subscales of emotional status of subjective well-being. Psychological follow-up during and after induction treatment with focus on depression, vigor, and fatigue could improve quality of life of these patients.

No relevant conflicts of interest to declare.