The Relationship of Depression and Anxiety and Impact of Cancer in Long-Term Survivors of Haematological Malignancy.

As survival rates continue to improve for patients with haematological malignancy, there is an increasing emphasis on quality of life (QOL) as an important treatment outcome. Long-term survivors can experience a variety of adverse physical late effects of cancer therapy. However, psychological, e.g. depression and anxiety, and social problems can also have profoundly adverse effects on patients' QOL that may not be adequately addressed in the management of long-term survivors.

In this retrospective cohort study of late effects in 718 British survivors of lymphoma and leukaemia (5–40 years since diagnosis), treated at a single centre, participants completed a series of questionnaires including the Hospital Anxiety and Depression Scale (HADS) and the Impact of Cancer (IOCv2) scale, which is a QOL instrument specifically designed to measure both positive and negative impacts of cancer in long-term survivors.

To examine the association between depression and anxiety (HADS) and QOL (IOCv2).

Ethical approval obtained from the National Research Ethics Service Ref: 11/NE/0095

All patients, aged ≥18 years at time of entry into study, with a confirmed diagnosis of haematological malignancy and alive ≥5 years since initial diagnosis, and who had received treatment at St. Bartholomew's Hospital, London (n=1,288) were sent a questionnaire comprising socio-demographic details and a series of medical and psychosocial measures, including IOCv2 and HADS. Responses were received from 718 (response rate = 56%) patients (280 Hodgkin's Lymphoma (HL), 326 Non-Hodgkin's lymphoma (NHL) [109 Diffuse Large B- Lymphoma (DLBCL), 128 Follicular Lymphoma (FL), 89 other NHL (ONHL)], and 112 Acute Leukaemia (AL)).

Spearman rank correlation between HADS scores and positive and negative scales of IOCv2 were examined, and, where significant, mean scores for each scale/domain were compared between groups scoring >15 on HADS (indicating a high possibility of clinical depressive or anxiety disorder) and ≤15, using multivariable linear regression analysis and adjusting for age, years since diagnosis, gender, relationship status and ethnicity in HL, DLBCL, FL/ONHL and AL respectively. Bonferroni corrections were used for multiple testing.

Fifteen percent (HL 14%; DLBCL 15%, FL/ONHL 18%; AL 16%) of participants had HADS scores >15 indicative of a clinical mood or anxiety disorder. There was no statistically significant difference between HADS scores across the diagnostic groups (P=0.65). There was a significant correlation between HADS scores and IOC negative impact scale scores (r=0.68, P<0.001) and all negative impact domains (r≥0.39, P<0.001) but no correlation with positive impact scale scores. Regression analysis of IOC negative impact scale scores showed significantly higher values (P<0.001) in patients with HADS >15 in all diagnostic groups after adjusting for current age, years since diagnosis, gender, relationship status and ethnicity (total 2.87 vs. 3.83; HL 3.24 vs. 3.90; DLBCL 3.28 vs. 4.40; FL/ONHL 2.81 vs. 3.90; AL 2.03 vs. 3.24). Similar significant results (P≤0.02) were also observed at the negative domain level. In the adjusted analyses, those who were in a relationship had significantly lower IOC negative impact scores than those who were not in a relationship in HL (P=0.01) and DLBCL, (P<0.05). In survivors of FL/ONHL and DLBCL, there was a significant reduction in mean negative impact scores of 0.2 per 10 years increase in survival time (P<0.01). Also, among HL survivors, there was a significant reduction in mean negative impact scores of 0.08 per 10 years increase in current age.

Levels of depression and anxiety symptoms are higher in long-term cancer survivors than in the general population and strongly correlated with negative impact of cancer in all types of haematological malignancy, regardless of prognosis. Other factors, such as age, years since diagnosis and degree of social support, are also contributory and a greater understanding of how these interact is needed to improve quality of life and other healthcare needs of long-term survivors.

Gribben:Celgene: Honoraria; Roche: Honoraria; Merck: Honoraria; Mundipharma: Honoraria; Pharmacyclics: Honoraria.