Background: More than half of patients newly diagnosed with lymphoma or myeloma experience clinically significant anxiety or depression symptoms. Although such high psychological burden impairs quality of life and may affect survival, little is known about patient perspectives on interventions to address psychological symptoms.

Methods: We conducted a 44-item survey from 07/2021 to 09/2022 to characterize anxiety and depression among patients with new diagnoses of lymphoma or myeloma recruited from a tertiary cancer center. Eligible patients were ≥18 years old and ≤ 6 months from their cancer diagnosis. The survey included the Hospital Anxiety and Depression Scale (Zigmond & Snaith, Acta Psychiatr Scand, 1983; subscale range 0-21; cutoff scores >7 indicating anxiety or depression) and patient perceptions on the value of 5 interventions to promote emotional coping: (1) Peer support from other patients, (2) Group support, (3) Therapist, (4) Self-directed online programs, and (5) Meditation apps. Response options to items on the value of interventions were on a 5-point Likert scale “not all helpful” to “extremely helpful.” We categorized “moderately to extremely helpful” as high value and “not at all to slightly helpful” low value. We also assessed self-stigma toward psychological interventions (range 10-50, with higher scores indicating greater stigma) and social stigma toward psychological interventions (range 0-20, with higher scores indicating greater stigma). We developed multivariable logistic regression models to characterize associations of sociodemographic factors with perceived value for interventions rated as having high value by >50% of respondents, with model selection based on evaluation of Akaike Information Criteria (AIC). Two-sided p values <0.05 were considered significant.

Results: Of 267 patients approached, 200 filled out the survey (response rate:74.9%). The analytic cohort included participants with complete responses for all five interventions (n=191). Most respondents (80.1%) had lymphoma. The median age was 60 years (interquartile range: 48, 68). Most respondents were male (53.4%), White (84.3%), and married/living with a partner (73.3%). Over half (58.6%) reported clinically significant anxiety and/or depression symptoms, with 53.9% meeting the cut-off for anxiety symptoms alone, and 28.3% for depression symptoms alone.

Peer support had the highest perceived value for promoting emotional coping at cancer diagnosis (74.9%), followed by self-directed online programs (68.1%), group support and therapists (both 62.3%). Meditation apps had the lowest perceived value (41.4%).

In multivariable analysis, participants had greater odds of placing high value on peer support if they had clinically significant anxiety or depression symptoms (Odds ratio [OR] 2.70, 95% Confidence interval [CI] 1.13-6.73), were single/separated/divorced/widowed (OR 2.88, 95% CI 1.06-8.86), or had higher social support scores (OR 1.29 per 10-pt increase; 95% CI 1.04-1.62). Conversely, individuals with low financial satisfaction had lower odds of valuing peer support (OR 0.34; 95% CI 0.13-0.81).

Patients with higher self-stigma toward psychological help had lower odds of placing high value on both self-directed online programs (OR 0.54 per 5-pt increase, 95% CI 0.39–0.74) and group support (OR 0.74 per 5-pt increase, CI 0.56-0.98).

Participants had greater odds of placing high value on therapists to promote emotional coping if they had clinically significant anxiety or depression symptoms (OR 3.24, 95% CI 1.49-7.34). On the other hand, patients had significantly lower odds of valuing therapists if they were older (OR 0.76 per 10-year increase, 95% CI 0.59-0.97), were single/separated/divorced/widowed (OR 0.40; 95% CI 0.16-0.98), or had higher self-stigma scores (OR 0.53 per 5-pt increase, 95% CI 0.38-0.73).

Conclusions: In this cohort of adults with newly diagnosed lymphoma or myeloma, we observed strong interest in interventions to promote emotional coping, with peer support the most highly valued. The perceived utility of peer support, particularly among patients with clinically significant anxiety or depression symptoms, supports its integration into standard psychological care for this patient population. Moreover, the modulating effect of self-stigma on the perceived usefulness of psychological interventions argues that stigma itself is a key barrier to effective mental health care for patients with blood cancers.

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2025
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