Factors That Dictate Mental Coping Strategies Used By Patients with Acute Myeloid Leukemia

Introduction:

How patients cope with a new diagnosis of a serious/life threatening disease has been studied in a variety of settings and diseases, but not in acute myeloid leukemia (AML). In AML patients are confronted with a unique situation of a life-threatening diagnosis and the prospect of intensive prolonged treatments ahead of them.

The aim of the current study is to assess different modes of coping with the diagnosis of AML, and whether these strategies remain stable over time.

Methods:

Adult patients with a new diagnosis of AML who were candidates for intensive chemotherapy and agreed to participate in this study were enrolled. The second author (Dr. Dorfman), a trained psychiatrist, and the chief of the Psycho-Oncology service in our institute, interviewed the patients at diagnosis and 3 months later. In these sessions the patients completed the Mental Adjustment to Cancer (MAC) questionnaire. The Hebrew version of this instrument was previously validated and consists of 40 items that assess the ability to cope with cancer and provides information on four major coping styles: fighting spirit, hopelessness/helplessness, anxious preoccupation and fatalistic acceptance. For each scale we calculated the standard (Z) score. The internal reliability measure (Cronbach's alpha) was above 0.7 for all scales. The sociodemographic interview gathered information on age, education, marital status, living arrangements, country of birth, religion and financial status. Additional medical information was obtained from the electronic medical record of each patient. We compared continuous variables using paired T-test and χ2 to compare categorical variables. We used a multivariate linear regression model to predict which of the baseline characteristics is associated with the coping strategy score.

Results:

We enrolled 18 patients with a recent diagnosis of AML. The median age was 55 years, and 12 (67%) were males. At time of diagnosis women, single patients (non-married or divorced), and patients with the lowest or highest income levels were significantly more anxious. Those who experienced a major life event within the previous year expressed lowers levels of hopelessness and a lesser degree of a fatalistic mode of coping. On the other hand, male patients, as well as unemployed or patients with low income, tended to express a higher degree of fatalistic feelings. Female patients were less likely to have high levels of fighting spirits.

The mode of coping did not remain constant over time, and scores in all 4 scales changed over time. In fact, MAC scores in our cohort at 3 months correlated with baseline scores only in the fatalistic scale ( r_p = 0.67, p = 0.006).

Conclusion:

In patients with newly diagnosed AML facing intensive chemotherapy, socioeconomics factors and life experience dictate, at least in-part, the coping strategy. However, 3 months after starting treatment, these factors become less influential. It is possible that at this stage, other factors, such as response to treatment, residual physical and mental resources and long-term prognosis become more important.