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Traumatic stress in acute leukemia

Authors

  • Gary Rodin,

    Corresponding author
    1. Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, Toronto, Canada
    2. Behavioural Sciences and Health Research Division, Toronto General Research Institute, University Health Network, Toronto, Canada
    3. Department of Psychiatry, University of Toronto, Toronto, Canada
    • Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada
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  • Dora Yuen,

    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada
    2. Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, Toronto, Canada
    3. Behavioural Sciences and Health Research Division, Toronto General Research Institute, University Health Network, Toronto, Canada
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  • Ashley Mischitelle,

    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada
    2. Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, Toronto, Canada
    3. Behavioural Sciences and Health Research Division, Toronto General Research Institute, University Health Network, Toronto, Canada
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  • Mark D Minden,

    1. Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, Toronto, Canada
    2. Division of Medical Oncology and Hematology, Princess Margaret Hospital, University Health Network, Toronto, Canada
    3. Department of Medical Biophysics, University of Toronto, Toronto, Canada
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  • Joseph Brandwein,

    1. Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, Toronto, Canada
    2. Division of Medical Oncology and Hematology, Princess Margaret Hospital, University Health Network, Toronto, Canada
    3. Department of Medicine, University of Toronto, Toronto, Canada
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  • Aaron Schimmer,

    1. Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, Toronto, Canada
    2. Division of Medical Oncology and Hematology, Princess Margaret Hospital, University Health Network, Toronto, Canada
    3. Department of Medical Biophysics, University of Toronto, Toronto, Canada
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  • Charles Marmar,

    1. Department of Psychiatry, New York University Langone Medical Center, New York, NY, USA
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  • Lucia Gagliese,

    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada
    2. Behavioural Sciences and Health Research Division, Toronto General Research Institute, University Health Network, Toronto, Canada
    3. School of Kinesiology and Health Science, York University, Toronto, Canada
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  • Christopher Lo,

    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada
    2. Behavioural Sciences and Health Research Division, Toronto General Research Institute, University Health Network, Toronto, Canada
    3. Department of Psychiatry, University of Toronto, Toronto, Canada
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  • Anne Rydall,

    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada
    2. Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, Toronto, Canada
    3. Behavioural Sciences and Health Research Division, Toronto General Research Institute, University Health Network, Toronto, Canada
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  • Camilla Zimmermann

    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada
    2. Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, Toronto, Canada
    3. Behavioural Sciences and Health Research Division, Toronto General Research Institute, University Health Network, Toronto, Canada
    4. Department of Medicine, University of Toronto, Toronto, Canada
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Correspondence to: Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, 610 University Ave., 16th Floor, Room-724, Toronto, Ontario, Canada M5G 2M9. E-mail: gary.rodin@uhn.ca

Abstract

Objective

Acute leukemia is a condition with an acute onset that is associated with considerable morbidity and mortality. However, the psychological impact of this life-threatening condition and its intensive treatment has not been systematically examined. In the present study, we investigate the prevalence and correlates of post-traumatic stress symptoms in this population.

Methods

Patients with acute myeloid, lymphocytic, and promyelocytic leukemia who were newly diagnosed, recently relapsed, or treatment failures were recruited at a comprehensive cancer center in Toronto, Canada. Participants completed the Stanford Acute Stress Reaction Questionnaire, Memorial Symptom Assessment Scale, CARES Medical Interaction Subscale, and other psychosocial measures. A multivariate regression analysis was used to assess independent predictors of post-traumatic stress symptoms.

Results

Of the 205 participants, 58% were male, mean age was 50.1 ± 15.4 years, 86% were recently diagnosed, and 94% were receiving active treatment. The mean Stanford Acute Stress Reaction Questionnaire score was 30.2 ± 22.5, with 27 of 200 (14%) patients meeting criteria for acute stress disorder and 36 (18%) for subsyndromal acute stress disorder. Post-traumatic stress symptoms were associated with more physical symptoms, physical symptom distress, attachment anxiety, and perceived difficulty communicating with health-care providers, and poorer spiritual well-being (all p < 0.05).

Conclusions

The present study demonstrates that clinically significant symptoms of traumatic stress are common in acute leukemia and are linked to the degree of physical suffering, to satisfaction with relationships with health-care providers, and with individual psychological characteristics. Longitudinal study is needed to determine the natural history, but these findings suggest that intervention may be indicated to alleviate or prevent traumatic stress in this population. Copyright © 2011 John Wiley & Sons, Ltd.

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