Цель. Выявить особенности влияния тревожных и депрессивных расстройств (ТДР) на приверженность лечению (ПЛ) и результаты лечения больных заболеваниями системы крови. Материалы и методы. В исследование включены 117 больных: 51 мужчина и 66 женщин, в возрасте 19–67 лет (медиана 33 года), с диагнозами: лимфома Ходжкина (ЛХ; n=88), острый лимфобластный лейкоз (n=16) и апластическая анемия (n=13). Критерием включения являлось наличие стажа заболевания не менее 4 мес и прохождение больными протокола амбулаторного лечения. Пациенты обследованы клинико-психопатологическим методом с использованием следующих методик: краткая психиатрическая оценочная шкала, шкала тревоги и депрессии Бека, стандартизированное многофакторное исследование личности, тип отношения к болезни и количественная оценка ПЛ. Результаты. ТДР выявлялись у 36 (40,9%) больных ЛХ, у 8 (50%) пациентов с острым лимфобластным лейкозом, у 3 (23,1%) больных с апластической анемией. Средняя ПЛ обнаруживалась у 2/3 больных, низкая и высокая – у остальных 1/3. ПЛ значимо отрицательно коррелирует с депрессией в целом, особенно с такими ее характеристиками, как пессимизм и нарушение социальных связей, а также с тревожным, меланхолическим и дисфорическим типами отношения к болезни. ПЛ значимо положительно коррелирует со зрелым (>45 лет) возрастом и такими типами отношения к болезни, как анозогнозический, ипохондрический и эгоцентрический (истерический). При средней и низкой ПЛ риск неблагоприятных событий выживаемости без прогрессии увеличивается в среднем в 1,7 раза. Заключение. ТДР способствуют снижению ПЛ и ухудшению результатов лечения больных заболеваниями системы крови. Выявление и коррекцию психического состояния больных следует проводить совместными усилиями врачей-гематологов и специалистов в области психического здоровья.
Ключевые слова: тревога, депрессия, приверженность лечению, заболевания системы крови
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Aim. To establish the features of the influence of anxiety and depressive disorders on treatment adherence, as well as to clarify the factors associated with it in hematologic malignancies patients. Materials and methods. The study included 117 patients: 51 men and 66 women, aged 19 to 67 years, with Hodgkin's lymphoma – 88, acute lymphoblastic leukemia – 16 and aplastic anemia – 13 patients. Patients were examined by psychiatrist using the Brief Psychiatric Rating Scale, as well as some psychometric methods. Results. Anxiety-depressive spectrum disorders were detected in 36 (40.9%) patients with Hodgkin's lymphoma and 8 (50%) with acute lymphoblastic leukemia, in the aplastic anemia group there were three (23.1%) of such patients. It was found that the average adherence to treatment was in 2/3 of patients, low and high – in the remaining 1/3 of patients. With medium and low adherence to treatment, the risk of adverse events increases by an average of 1.7 times. The adherence to treatment it is significantly higher in patients older than 45 years. Signs of depression that negatively correlated with adherence to treatment were pessimism and disruption of social ties. Adherence to treatment significantly positively correlates with the following types of attitudes towards the disease: anosognosic, hypochondriac and egocentric, and significantly negatively correlates with the following types of attitudes towards the disease: anxious, melancholic and dysphoric. Conclusion. Anxiety/depressive disorders contribute to reduced adherence of hematologic malignancies patients to treatment. Their correction and increased adherence should be carried out jointly by hematologists and mental health professionals.
Keywords: anxiety, depression, adherence to treatment, diseases of the blood system
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Suppl. 1:19-25. DOI:10.1097/00002030-200418001-00004
________________________________________________
1. Honda K, Goodwin RD. Cancer and mental disorders in a national community sample: findings from the national comorbidity survey. Psychother Psychosom. 2004;73:235-42. DOI:10.1159/000077742
2. Abuelgasim KA, Ahmed GY, Alqahtani JA, et al. Depression and anxiety in patients with hematological malignancies, prevalence, and associated factors. Saudi Med J.
2016;37(8):877-81. DOI:10.15537/smj.2016.8.14597
3. Papathanasiou IV, Kelepouris K, Valari C, et al. Depression, anxiety and stress among patients with hematological malignancies and the association with quality of life: a cross-sectional study. Med Pharm Rep. 2020;93(1):62-8. DOI:10.15386/mpr-1502
4. Pamuk GE, Harmandar F, Ermantaş N, et al. EORTC QLQ-C30 assessment in Turkish patients with hematological malignancies: association with anxiety and depression. Ann Hematol. 2008;87(4):305‑10. DOI:10.1007/s00277-008-0445-4
5. Seo HJ, Baek YG, Cho BS, et al. Anxiety and Depression of the Patients with Hematological Malignancies during Hospitalization for Hematopoietic Stem Cell Transplantation. Psychiatry Investig. 2019;16(10):751-8. DOI:10.30773/pi.2019.07.12
6. Ng AK, Li S, Recklitis C, et al. Health practice in long-term survivors of Hodgkin's lymphoma. Int J Radiat Oncol Biol Phys. 2008;71(2):468-76. DOI:10.1016/j.ijrobp.2007.09.028
7. Parker PA, Banerjee SC, Matasar MJ, et al. Protocol for a cluster randomised trial of a communication skills intervention for physicians to facilitate survivorship transition in patients with lymphoma. BMJ Open. 2016;6(6):e011581. DOI:10.1136/bmjopen-2016-011581
8. Chamberlain FE, Walsh N, Falkowski J. Chemotherapy for Hodgkin's lymphoma in a patient receiving clozapine for treatment-resistant schizophrenia: use of the Mental Capacity Act 2005. BJPsych Bull. 2015;39(6):305-7. DOI:10.1192/pb.bp.114.048306
9. Greenberg DR, Khandwala YS, Lu Y, et al. Disease burden in offspring is associated with changing paternal demographics in the United States. Andrology. 2020;8(2):342-7. DOI:10.1111/andr.12700
10. Augustin NB, Maroules M. Hyperleukocytosis during clozapine treatment: A rare presentation of B-cell Acute lymphoblastic leukemia. Leuk Res Rep. 2021;15:100253. DOI:10.1016/j.lrr.2021.100253
11. Vybornykh DE, Fedorova SYu, Khrushchev SO, et al. Cognitive impairment in patients with hematological malignancies who underwent transplantation of allogeneic hematopoietic stem cells. VM Bekhterev Obozrenie psikhiatrii i meditsinskoi psikhologii. 2019;2:20‑36 (in Russian). DOI:10.31363/2313-7053-2019-2-20-36
12. Koroleva AA, Vybornykh DE, Polyanskaya TYu, et al. Traumatological and surgical care for patients with hemophilia with comorbid mental pathology. Kremlevskaia meditsina. Klinicheskii vestnik. 2020;1:46-57 (in Russian). DOI:10.26269/4xms-8g82
13. Oleksenko LV, Vybornykh DE. Mental disorders in Hodgkin's lymphoma. Zhurnal nevrologii i psikhiatrii im. SS Korsakova. 2017;117(8):124-31 (in Russian). DOI:10.17116/jnevro201711781124-131
14. Pedersen AF, Zachariae R. Cancer, acute stress disorder, and repressive coping. Scand J Psychol. 2010;51(1):84-91. DOI:10.1111/j.1467-9450.2009.00727.x
15. Ell KO, Nishimoto RH, Mantell JE, Hamovitch MB. Psychological adaptation to cancer: A comparison among patients, spouses, and nonspouses. Family Systems Medicine. 1988;6(3):335-48. DOI:10.1037/h0089745
16. Cella DF, Orav EJ, Kornblith AB, et al. Socioeconomic status and cancer survival. J Clin Oncol. 1991;9(8):1500-9. DOI:10.1200/JCO.1991.9.8.1500
17. Kolgaeva EI, Drokov MYu, Vybornykh DE, et al. Peculiarities of adherence to the treatment of patients before allo-HSCT. Kletochnaia Terapiia i Transplantaciia. 2021;10(3):118-9 (in Russian). DOI:10.18620/ctt-1866-8836-2021-10-3-1-14818.
18. Fernsler J, Fanuele JS. Lymphomas: long-term sequelae and survivorship issues. Semin Oncol Nurs. 1998;14:321-8. DOI:10.1016/S0749-2081(98)80010-7
19. Tamaroff MH, Festa RS, Adesman AR, Walco GA. Therapeutic adherence to oral medication regimens by adolescents with cancer. II. Clinical and psychologic correlates. J Pediatr. 1992;120(5):812-7. DOI:10.1016/s0022-3476(05)80257-4
20. Horne R, Weinman J. Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res.
1999;47(6):555-67. DOI:10.1016/s0022-3999(99)00057-4
21. Hinkin CH, Hardy DJ, Mason KI, et al. Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS. 2004;18
Suppl. 1:19-25. DOI:10.1097/00002030-200418001-00004
1 ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава России, Москва, Россия;
2 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*dvyb@yandex.ru
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Dmitry E. Vybornykh*1, Tatiana N. Moiseeva1, Eduard G. Gemdzhian1, Tatiana V. Gaponova1, Liubov V. Esina1,2, Elmira I. Kolgaeva1, Daria V. Novikova1
1 National Medical Research Center for Hematology, Moscow, Russia;
2 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*dvyb@yandex.ru