Timing and diagnosis informs psychological support needs

Patterns of anxiety and depression differ between haematological cancers and change over time from diagnosis suggesting that psychological support needs to be targeted and specific to be effective.

study of more than 236 patients with diffuse large B-cell lymphoma (DLBCL) and 178 patients with multiple myeloma in their early survivorship period found relatively low but dynamic rates of distress.

About 14% of patients with DLBCL and 15% of patients with multiple myeloma had elevated anxiety scores at seven months as measured by the Hospital Anxiety and Depression Scale (HADS).

Anxiety levels rose to 22% in the lymphoma group 15 months after diagnosis, however they remained relatively stable (12%) in patients with multiple myeloma.

Conversely, elevated depression scores in DLBCL patients were stable at both time points (15 and 16%) but fell from 22 to 12% over time in the multiple myeloma patients.

Dr Vicki White, principal research fellow in Cancer Council Victoria’s Centre for Behavioural Research in Cancer, said symptom burden and typical disease course were likely influences. However the study found little evidence for an effect of treatment on either anxiety or depression.

She told the limbic patients with DLBCL might find the period following initial treatment anxiety provoking when they had less intensive contact with health professionals but knew treatment failure could still occur.

Patients with multiple myeloma and a poorer prognosis overall may find their diagnosis initially distressing but move towards acceptance over time.

“We need to monitor the psychological health and wellbeing of cancer survivors and put in place screening for distress. However we need to ensure it is not just a one-off check and instead look at it over the course of their disease,” she said.

“We also need to put in place mechanisms of referral to other services including community health.”

The study suggested people were not so distressed that they required professional support from psychologists.

“We need to be giving people a management plan for post-treatment care and resources that might be helpful.”

Dr White said patients often felt they were ‘overloaded’ with information and support at diagnosis but could be left ‘high and dry’ later in their cancer journey.

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