Myeloproliferative Neoplasms and Depressive Symptoms, Diagnosis, and Associations

Patients with a myeloproliferative neoplasm (MPN) diagnosis experience a high systemic symptom burden and a spectrum of physical, financial, mental and emotional stressors. The impact of mood disturbances in MPN patient is not well understood. It was recently identified by our study team that symptoms of depression coexist with the prevalent and debilitating symptom of fatigue in patients with MPNs. The purpose of this study is to comprehensively describe the experience of depressive symptoms in MPN patients.

Methods: A 70-item internet based national survey regarding fatigue and mood symptoms was developed by MPN investigators and patient/advocates and refined by the Mayo Clinic Survey Research Center. The Patient Health Questionnaire-2 (PHQ) was completed by all respondents and utilized to assess symptoms of depression. Survey responses were compared between those who endorsed having current symptoms of depression (defined as a PHQ-2 score ≥ 3) and those without symptoms of depression (defined as a PHQ-2 score < 3).

Results:

Demographics: 1389 patients across the country with MPNs completed the survey. The mean age was 59 years (standard deviation [SD] 11.7) with a predominance of female respondents (68%). Self-reported diagnoses included polycythemia vera (PV) (550/1389, 40%), essential thrombocythemia (ET) (445/1389, 32%), myelofibrosis (MF) (349/1389, 25%), and other (41/1389, 3%). There were 318 respondents (23%) with PHQ-2 scores ≥ 3 (122/550, 22% PV; 107/445, 24% ET; 80/349, 22% MF; other 8/41, 3%).

MPN Related History: MPN diagnosis and gender frequency did not differ between depression symptom classification groups (P=0.86 and P=0.80, respectively). There were no differences in the use of particular MPN directed treatments between depression symptom groups (including phlebotomy 52% PHQ≥3, P=0.39; medications 87% PHQ≥3, P=0.38; JAK inhibitor use specifically 17% PHQ≥3, P=0.36; interferon use specifically 21% PHQ ≥3, P=0.19; or transfusions 18% PHQ≥3, P=0.10). However, a thrombosis history was more associated with depressive symptoms (23% vs 17%; P=0.008).

A PHQ score of ≥3 was associated with younger age (mean 57.0 (SD 12.1) vs 59.5 (SD 11.5) years; P <0.001) and an overall more recent MPN diagnosis (P=0.02) (<1 year, 12% vs 7%; 1 to 3 years, 21% vs 20%; >3 years ago, 67% vs 73%).

MPN Related Symptoms: A PHQ score ≥3 was associated with a higher MPN-SAF Total Symptom Score (mean 41.1 (SD 16.7) vs 24.7 (SD 15.9); P <0.001) with all 10 individual symptoms being statistically significantly higher including fatigue (mean 7.8 (SD 1.9) vs 5.8 (SD 2.7); P <0.001).

Mood Treatment: Patients with PHQ≥3 more often utilized medication for mood problems (87% vs 77%; P=0.03), and used counseling/therapy at similar rates (38% vs 41%; P=0.63) compared to patients without symptoms of depression.

Conclusion: The presence of significant depressive symptoms is not uncommon in patients with MPNs. Mood disturbances were not associated with MPN-related therapy options but were associated with worse systemic symptoms. These findings indicate depressive symptomatology may be intrinsic to the condition, and not a result of treatment side effects. Additionally, the association of depressive symptoms was impacted by time from diagnosis, suggesting that patients with recent diagnosis may have the highest risk for depression. Given that almost one-fourth of the patients endorsed having symptoms of depression better understanding of the mood disturbances impacting MPN patients is warranted. Comprehensive health care for patients with MPNs should include investigation into interventions targeting mood disturbances that may improve health related quality of life and may prove to mitigate the severity of MPN-related symptoms, specifically fatigue.