Abstract
Introduction Acute leukemia (AL) is a life-threatening hematologic malignancy that often necessitates urgent hospitalization and rapid initiation of intensive, frequently toxic, therapies within hours to days of diagnosis. AL carries a markedly higher acuity than most cancers and presents with great variability in illness trajectories, treatment paradigms, and potentials for cure – even in the relapsed and refractory settings. The unique clinical dynamics of AL care often disrupt multiple domains of quality-of-life (QOL), including psychosocial, physical, emotional, and spiritual well-being. Patients with newly diagnosed AL are often confronted with multiple time-sensitive, complex decisions which can lead to profound spiritual distress as they navigate the emotional and existential impact of their illness. While increased spiritual wellness (SW) has been associated with improved physical functionality and QOL in patients with advanced cancers, particularly at the end-of-life, its role remains poorly understood in the distinct context of newly diagnosed AL. To address this gap, we conducted a prospective observational multi-methods study at the University of Chicago using patient-reported outcome measures (PROMs) to evaluate SW and QOL among adults with newly diagnosed AL receiving initial therapy. We evaluated early changes in PROMs and investigated the relationship between SW and QOL in this population.
Methods Adult patients with newly diagnosed AL were prospectively enrolled and completed validated PROMs assessing SW (FACIT-Sp12) and QOL (FACT-Leu) within 7 days of AL diagnosis and again 30 days later. Five additional free-response questions exploring areas of spiritual practices, coping mechanisms, community support, and changes in outlook were asked at both time points and coded thematically using an open, double-coded approach.
PROM changes over time were assessed via paired t-tests. The relationship between PROMs were assessed with Pearson correlation coefficients. Patients' SW scores were then stratified categorically into low, average, or high spirituality levels based on established national data (Munoz et al., Cancer, 2015). Chi-square tests examined associations between patients' spirituality levels and selected sociodemographic or biologic factors at both time points.
Results
Thirty patients were enrolled and completed all assessments. The median age was 52 years (range 21-93), 60% were female, and 53% had acute myeloid leukemia. All patients received disease-specific therapy during hospitalization.
Qualitative analysis revealed 3 core themes: personal practice, community support, and perceived growth. Personal practices most commonly included prayer, meditation, and positive thinking. Community support ranged from spouses and family members to friends and religious/spiritual groups. Finally, 53% (16/30) reported a positive change in outlook, comfort, or hope between baseline and day 30.
While the mean SW score did not significantly increase from enrollment to day 30 (36.5 vs 37.8, p = 0.31), QOL scores did significantly improve over the same period (111.3 vs 129, p = 0.022). SW had moderate, significant positive correlations with QOL at both enrollment (r = 0.47, p = 0.012) and day 30 (r = 0.43, p = 0.022). The distribution of patients' spirituality levels was 13.3% low, 76.7% average, and 10% high at enrollment; and 13.3%, 73.3%, and 13.3%, respectively, at day 30. Four patients (13%) demonstrated an increase in spirituality level between enrollment and day 30 (2 from low to average and 2 from average to high). Patients in the low spirituality level at enrollment were significantly more likely to have higher household income (50% with $100,000 or more, p = 0.044). No other sociodemographic or biologic factor differed significantly by spirituality level at either time point.
Conclusions
While SW is significantly correlated with QOL, only QOL significantly improved in the first 30 days following AL diagnosis and treatment initiation. This finding suggests that QOL in this population could improve further through a multidisciplinary care model that actively supports SW. During hospitalization for AL, many personal and community-based sources of encouragement, hope, and strength are often disrupted, which can contribute to spiritual distress. Integrating spiritual care into AL treatment paradigms has the potential to enhance patient-centered care and improve patient-reported outcomes.
