Relationship Between Longitudinal Coping Strategies and Outcomes in Patients With Acute Myeloid Leukemia

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Hermioni L. AmonooDepartment of Psychiatry, Brigham and Women’s Hospital,
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, and
Harvard Medical School, Boston, Massachusetts;

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Elizabeth DaskalakisDepartment of Psychiatry, Brigham and Women’s Hospital,

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Emma C. DearyDepartment of Psychiatry, Brigham and Women’s Hospital,

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Monica H. BoddDuke University School of Medicine, Durham, North Carolina;

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Matthew J. ReynoldsDivision of Hematology and Oncology, Department of Medicine, and

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Ashley M. NelsonHarvard Medical School, Boston, Massachusetts;
Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts;

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Richard NewcombDivision of Hematology and Oncology, Department of Medicine, and

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Tejaswini M. DhawaleDivision of Hematology and Oncology, Department of Medicine, and

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Daniel YangDivision of Hematology and Oncology, Department of Medicine, and

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Selina M. LugerDivision of Hematology Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;

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Jillian L. GustinDivision of Palliative Medicine, The James Cancer Hospital, Ohio State University, Columbus, Ohio; and

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Andrew BrunnerHarvard Medical School, Boston, Massachusetts;
Division of Hematology and Oncology, Department of Medicine, and

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Amir T. FathiHarvard Medical School, Boston, Massachusetts;
Division of Hematology and Oncology, Department of Medicine, and

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Thomas W. LeBlancDivision of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.

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Areej El-JawahriHarvard Medical School, Boston, Massachusetts;
Division of Hematology and Oncology, Department of Medicine, and

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Background: Patients with acute myeloid leukemia (AML) face an abrupt life-threatening illness and experience immense physical and psychological symptoms. However, no data describe how patients with AML cope longitudinally with their illness or the relationship between longitudinal coping and outcomes. Methods: We conducted a secondary analysis of longitudinal data from 160 patients with high-risk AML enrolled in a supportive care intervention trial to describe coping strategies longitudinally across the illness course. We used the Brief COPE questionnaire, the Hospital Anxiety and Depression Scale, the Post-Traumatic Stress Disorder (PTSD) Checklist-Civilian Version, and the Functional Assessment of Cancer Therapy-Leukemia to measure coping strategies, psychological distress, and quality of life (QoL) at baseline and at weeks 2, 4, 12, and 24 after diagnosis. Electronic health records were used to assess healthcare utilization and end-of-life (EoL) outcomes, and multivariate analyses were used to assess the relationship between coping and outcomes. Results: Longitudinal utilization of approach-oriented coping strategies was significantly associated with less distress (anxiety: β, –0.18; P<.001; depression symptoms: β, –0.42; P<.001; PTSD symptoms: β, –0.60; P<.001) and better QoL (β, 2.00; P<.001). Longitudinal utilization of avoidant coping strategies was significantly associated with greater distress (anxiety: β, 0.64; depression symptoms: β, 0.54; PTSD symptoms: β, 2.13; P<.001 for all) and worse QoL (β, –4.27; P<.001). Although the use of approach-oriented and avoidant coping strategies was not significantly associated with hospitalization, chemotherapy administration, or hospice use in the last 30 days of life, approach-oriented coping was associated with lower odds of ICU admissions (odds ratio, 0.92; P=.049). Conclusions: Longitudinal use of approach-oriented coping strategies was associated with less psychological distress, better QoL, and a lower likelihood of ICU admission, suggesting a possible target for supportive oncology interventions. Coping strategies did not impact EoL outcomes, and further research is needed to elucidate which patient factors impact EoL decision-making.

Submitted December 28, 2021; final revision received April 12, 2022; accepted for publication June 15, 2022.

Author contributions: Conception and design: Amonoo, El-Jawahri. Acquisition of data: Reynolds, Newcomb, Yang, Luger, Gustin, Brunner, Fathi, LeBlanc, El-Jawahri. Data analysis and interpretation: Amonoo, El-Jawahri. Manuscript preparation: All authors. Critical revisions for important intellectual content: All authors.

Disclosures: Dr. Fathi has disclosed serving as a consultant for AbbVie, Inc., Amgen Inc., Astellas Pharma US, Inc., Bristol-Myers Squibb Company, Celgene Corporation, EnClear Therapies, Inc., Forma Therapeutics Inc., Genentech, Inc., ImmunoGen, Inc., Ipsen, Mablytics, Inc., Novartis Pharmaceuticals Corporation, Orum Therapeutics, Servier Laboratories, and Takeda Pharmaceuticals North America, Inc.; receiving grant/research support from AbbVie, Inc., Bristol-Myers Squibb Company, and Servier Laboratories; and serving as a scientific advisor for Takeda Pharmaceuticals North America, Inc. Dr. LeBlanc has disclosed serving as a consultant for AbbVie, Inc., Agios, Inc./Servier Pharmaceuticals, Astellas Pharma US, Inc., AstraZeneca Pharmaceuticals plc, Blue Note Therapeutics, Celgene Corporation/Bristol-Myers Squibb Company, Genentech, Inc., GlaxoSmithKline, Pfizer, Inc., Flatiron, and Novartis; serving on the speakers bureau for AbbVie, Agios/Servier Pharmaceuticals, Bristol-Myers Squibb/Celgene; receiving royalties from UpToDate; and receiving grant/research support from Jazz Pharmaceuticals. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Research reported in this publication was supported by the NCI of the NIH under award number K08CA251654 (H.L. Amonoo).

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Data availability statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Correspondence: Hermioni L. Amonoo, MD, MPP, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 60 Fenwood Road, 4th Floor, Boston, MA 02115. Email: hermioni_amonoo@dfci.harvard.edu
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