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Profound Symptom Burden of Myeloproliferative Neoplasms Highlighted in New Studies

February 2018, Vol 9, No 1 | Payers' Perspectives In Oncology: ASH 2017 Highlights

Atlanta, GA—A pair of recent studies from the Mayo Clinic underscore the serious symptom burden experienced by patients diagnosed with myeloproliferative neoplasms (MPNs), according to data presented at ASH 2017. Specifically, patients with MPNs are at high risk for depression, and those with Philadelphia chromosome–negative disease are afflicted with sleep and psychiatric disturbance as well.

“The presence of significant depressive symptoms is not uncommon in patients with MPNs,” said Leslie Padrnos, MD, Hematology Oncologist, Seattle Cancer Care Alliance, WA, and lead investigator of the first study. “Mood disturbances were not associated with MPN-related therapy options, but were associated with worse systemic symptoms. These findings indicate depressive symptomatology may be intrinsic to the condition, and not a result of treatment side effects.”

Krisstina L. Gowin, DO, Professor of Hematology, Mayo Clinic Arizona, Fife, WA, and lead investigator of the second study, emphasized “the prevalence and potential undertreatment of sleep and psychiatric disturbance in those afflicted with MPN.”

Study 1

For the first study, Dr Padrnos and colleagues surveyed 1389 patients with MPNs in the United States, using the self-reported Patient Health Questionnaire-2 (PHQ-2). Among the PHQ-2 survey responders, 318 (23%) had scores of ≥3, indicating symptoms of depression.

The self-reported diagnoses among the total 1389 patients with MPNs included 550 (40%) patients with polycythemia, 445 (32%) with essential thrombocythemia, 349 (25%) with myelofibrosis, and 41 (3%) with other conditions.

Although no differences were found in the use of particular MPN-directed treatments between the depression symptom groups, a history of thrombosis was found to be associated with increased depressive symptoms, according to the investigators.

Depression was also associated with younger age and a more recent MPN diagnosis, said Dr Padrnos, suggesting that patients with a relatively new diagnosis may have the highest risk for depression. Finally, patients with PHQ-2 scores of ≥3 used drugs to treat mood problems more often than patients without symptoms of depression (87% vs 77%, respectively).

“Given that almost one-fourth of the patients endorsed having symptoms of depression, a better understanding of the mood disturbances ­impacting patients with MPN is warranted,” Dr Padrnos said. “Comprehensive healthcare for patients with MPNs should include an investigation into interventions targeting mood disturbances that may improve health-related quality of life and may prove to mitigate the severity of MPN-related symptoms, specifically fatigue.”

Study 2

In the second study, Dr Gowin and colleagues recruited 1087 patients from around the world via social media to complete similar self-report surveys. The self-reported diagnoses included 338 patients with essential thrombocytosis, 188 patients with myelofibrosis, 315 with polycythemia vera, and 17 with other conditions.

Difficulty staying asleep was reported by 447 (52.1%) patients, Dr Gowin reported. In addition, 289 (33.7%) patients reported difficulty falling asleep, whereas 268 (31.2%) and 159 (18.5%) patients, respectively, reported insomnia and sleeping too much.

The investigators also noted that only 20.9% of the population received mental health treatment, including medication use, counseling, and/or group therapy.

Of 172 patients who received mental health treatment in the past 6 months, 131 received medications, 74 received counseling, and 6 participated in group therapy.

“Patients self-reported depression more often than revealed by the PHQ-2,” said Dr Gowin. “Clearly, more studies are needed to understand optimal screening and treatment strategies in the MPN patient population.”

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