Anxiety and Depression Among Patients Newly Diagnosed with Lymphoma and Myeloma

Background: Although a diagnosis of lymphoma or myeloma confers physical and psychological burdens, data are sparse regarding anxiety and depression symptoms in affected patients. These data are critical for developing effective interventions to address these psychological challenges. We sought to characterize self-reported anxiety and depression in a cohort of adults with newly-diagnosed lymphoma or myeloma.

Methods: In July 2021, we initiated a 44-item survey to characterize anxiety and depression among patients with new diagnoses of lymphoma or myeloma recruited from a large cancer center. Eligible patients were ≥ 18 years and within 6 months of their initial cancer diagnosis. Participants could complete the survey online or on paper. We developed the survey from a literature review and with cognitive debriefing of 6 patients newly diagnosed with either malignancy. The survey included the Hospital Anxiety and Depression Scale (subscale range 0- 21; cutoff scores >7 indicating anxiety or depression); the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-C30 overall quality of life (QOL) scale (range 1-7, with higher scores indicating better QOL); and the modified Medical Outcomes Study-Social Support scale (range 0-100; with higher scores indicating more social support). We characterized sociodemographic factors associated with anxiety and depression in univariable analysis, and then built multivariable logistic regression models including factors with p<0.05 to assess variables independently associated with each outcome. We also assessed the potential relationship of anxiety and depression with QOL. Two-sided p values <0.05 were considered significant.

Results: As of July 2022, 192 of 238 patients approached had completed the survey (response rate: 80.7%). The median age of responders was 60 years (interquartile range [IQR] 49, 69). Most (80.2%) had lymphoma, with 19.8% myeloma. The majority of respondents were male (55.2%), White (85.9%), and married or living with a partner (73.4%; Table). Over half of the cohort (56.3%) had anxiety and/or depression with 51.6% of respondents meeting the cutoff for anxiety, and 27.6% for depression. In univariable analysis, age ≤ 60 years, female gender, being unmarried/not living with a partner, lack of extra money at the end of the month, not being “very/completely satisfied” with finances, and a social support score below the mean were associated with higher likelihood of experiencing anxiety. In multivariable analysis, age ≤ 60 years (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.17-4.29), female gender (OR 2.29 95% CI 1.18-4.46), and low financial satisfaction (OR 2.24, 95% CI 1.01-4.98) remained significantly associated with higher odds of anxiety. Patients with anxiety were more likely to report lower QOL compared to those without anxiety (mean [SD]: 4.75 [1.39] vs. 5.65 [1.25], p< 0.001). In univariable analysis, patients who reported a social support score below the mean and those who reported not being “very/completely satisfied” with their finances were more likely to have depression. In multivariable analysis, low social support (OR 2.28, 95% CI 1.15-4.51) and low levels of satisfaction with finances (OR 2.61, 95% CI 1.30-5.22) were significantly associated with experiencing depression. Patients with depression also reported lower QOL versus those without depression (3.96 [1.22] vs. 5.65 [1.16], p< 0.001).

Conclusions: In this large cohort of patients newly diagnosed with lymphoma or myeloma, we found a substantial psychological burden, with the majority experiencing anxiety and/or depression. We found a strong association of these symptoms with lower QOL for patients living with a new blood cancer, suggesting that interventions aimed at managing psychosocial distress could improve the lived experience of these diseases in their peri-diagnostic phase. Moreover, the association of financial burden and lower social support with depression suggests a critical need for psychosocial interventions to specifically target these factors.