Palliative care and coping in patients with acute myeloid leukemia receiving intensive induction therapy: A mediation analysis of data from a randomized trial.
Integrated palliative and oncology care (IPC) as part of induction chemotherapy for acute myeloid leukemia (AML) facilitates active coping strategies for patients, while reducing avoidant coping. Improvement in coping skills accounts for a substantial proportion of the effect from a palliative care intervention on quality of life (QOL), depression, and anxiety symptoms. A non-blinded, multi-site randomized trial of IPC versus usual care for hospitalized patients with AML receiving induction therapy was conducted. Patients completed the Functional Assessment of Cancer Therapy-Leukemia scale, the Hospital Anxiety and Depression Scale, and the Brief COPE questionnaire, to assess QOL, mood, and coping at baseline and weeks 2, 4, 12, and 24. To facilitate analysis, coping strategies were categorized into “approach-oriented” or “avoidant”. Causal mediation regression models were used to examine whether changes in coping during the initial hospitalization mediated intervention effects on QOL, depression and anxiety symptoms at week 2.
Patients randomized to IPC reported more approach-oriented coping and less avoidant-oriented coping at week 2. Intervention effects on approach-oriented coping were sustained up to week 24, but not on avoidant-oriented coping. Changes in approach-oriented coping and avoidant-oriented coping during hospitalization partially mediated the intervention effects on week 2 QOL, depression, and anxiety symptoms. Changes in approach- and avoidant-oriented coping accounted for 78% of the total palliative care intervention effect on QOL; 66% of the intervention effect on depression; and 35% of the intervention effect on anxiety.