Depression Worsens Symptom Burden in Patients With MPNs, Study Says

Depressive symptoms are common among patients with myeloproliferative neoplasms (MPNs), according to an international survey of patients, and researchers report that suggests depression contributes to and confounds the manifestation of the disease.

Among the 1300 respondents of the survey, nearly 1 in 4 exhibited depressive symptoms, as shown by a score of at least 3 on the Patient Health Questionnaire-2, which indicates patients at high risk of depression rather than diagnosing depression.

Notably, the survey results indicated that having worse depressive symptoms worsened the systemic symptom burden for patients. These patients scored significantly higher on the Myeloproliferative Neoplasm Symptom Assessment Form (mean 40.8 vs 24.6; P <.001), higher worst fatigue score (mean 7.8 vs 5.8; P <.001), and worse overall quality of life (mean 5.7 vs 3.1; P <.0001).

For fatigue specifically, the researchers observed differences in timing among patients. For those exhibiting depressive symptoms, they were more likely to feel fatigued all day (42.7% vs 17.5%, P <.0001), whereas patients not expressing depressive symptoms were more likely to feel fatigued at night (47% vs 35%, P <.001).

Across MPN types, higher depressive symptoms were associated with higher levels of systemic symptoms in polycythemia vera and myelofibrosis and were associated with higher levels of systemic symptoms across all but 2 constitutional symptoms in essential thrombocythemia.

“The presence of constitutional symptoms impact prognostic scoring for myelofibrosis and is a key feature in therapy response in JAK2 inhibition, indicating the importance of the presence and mitigation of these physiologic experiences,” wrote the researchers. “The association of MPN constitutional symptoms with prominent depressive symptoms suggests that heavy constitutional symptom burden leads to depressive symptoms and addressing the MPN symptom severity, through pharmacological or nonpharmacological therapies, may improve symptoms of depression.”

Of the 300 patients exhibiting depressive symptoms based on survey results, 38% had a score of 3, 29% had a score of 4, and 17% had a score of 6. These respondents were more likely to smoke(10.9% vs 5%, P = .0003), use prescription pain medication (24.4% vs 10.6%, P<.0001), use antidepressants (31.3% vs 11.9%, P <.0001), and use anxiety medications (15.4% vs 8.6%, P = .0005). They were also less likely to regularly exercise (P <.0001).

According to the researchers, the identified risk of depressive symptoms among these patients is consistent with reports of such symptoms in other hematologic malignancies, which “suggests that patients with MPN diagnosis, regardless of treatment type, have a similar risk of depressive symptoms as individuals with high risk hematologic malignancies undergoing aggressive, often intravenous treatment.”

Reference

Padrnos L, Scherber R, Geyer H, et al. Depressive symptoms and myeloproliferative neoplasms: understanding the confounding factor in a complex condition. Cancer Med. Published online September 25, 2020. doi: 10.1002/cam4.3380.