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Abstract：
BACKGROUND: Patients not only experience symptoms caused by cancer but also suffer from the accompanying psychological pain. Therefore, these patients do not have high quality of life. According to the World Health Organization, the incidence of leukemia in China in 2020 was 5.1/100000, the mortality rate was 3.3/100000, and the prevalence rate was 16.7/100000. Therefore, it is important to examine the influence of comorbid subthreshold depressive symptoms on leukemia patients.
OBJECTIVE: To determine the impact of comorbid subthreshold depressive symptoms on cancer-related fatigue and complications in leukemia patients, thereby providing a basis for early diagnosis and treatment in clinical practice.
METHODS: A questionnaire survey was conducted among leukemia patients admitted to a tertiary hospital in Xi\'an, Shaanxi Province, China, from August 2022 to December 2023. Patients with a score > 16 on the Chinese Classification of Mental Disorders (CCMD-3) and a Hamilton Depression Rating Scale score of 8-17 were classified as the subthreshold depressive group (n = 95), while 100 leukemia patients admitted during the same period were classified as the control group. Data were collected using Epidata 3.1 software, and comparisons were made between the two groups regarding general clinical data, the Piper Fatigue Scale (PFS), the Pittsburgh Sleep Quality Index (PSQI), the Numeric Rating Scale for pain assessment, laboratory indicators, and the occurrence of complications.
RESULTS: In this survey, 120 leukemia patients with depression were preliminarily screened, 95 patients with subthreshold depression were ultimately selected as the subthreshold depression group, and 100 leukemia patients admitted during the same period were enrolled as the normal group. Comparison of basic clinical data between the two groups revealed no significant differences in age, sex, body mass index, cognitive function, or comorbidity with other chronic diseases. However, there were statistically significant differences in the use of radiotherapy and regular exercise between the two groups (P < 0.05). Comparisons of scales and laboratory indicators revealed no significant differences in albumin or PSQI scores between the two groups, but there were statistically significant differences in pain scores, PSQI scores, PFS scores, hemoglobin levels, and C-reactive protein levels (P < 0.05). Spearman\'s correlation analysis indicated that cancer-related fatigue was correlated with age, hemoglobin levels, C-reactive protein levels, pain, and regular exercise among leukemia patients with subthreshold depression. Multivariate regression analysis revealed that advanced age, combined radiotherapy, pain, and low hemoglobin levels were risk factors for cancer-related fatigue in leukemia patients with comorbid subthreshold depression, while regular exercise was a protective factor against cancer-related fatigue. Follow-up comparisons revealed a significantly lower overall incidence of complications in the control group (4%) than in the depressive group (24.21%; P < 0.001).
CONCLUSIONS: Leukemia patients with comorbid subthreshold depressive symptoms experience more severe cancer-related fatigue and a higher incidence of complications. These findings may be related to advanced age, combined radiotherapy, pain, and low hemoglobin levels, while regular exercise may effectively alleviate symptoms.
OBJECTIVE: To determine the impact of comorbid subthreshold depressive symptoms on cancer-related fatigue and complications in leukemia patients, thereby providing a basis for early diagnosis and treatment in clinical practice.
METHODS: A questionnaire survey was conducted among leukemia patients admitted to a tertiary hospital in Xi\'an, Shaanxi Province, China, from August 2022 to December 2023. Patients with a score > 16 on the Chinese Classification of Mental Disorders (CCMD-3) and a Hamilton Depression Rating Scale score of 8-17 were classified as the subthreshold depressive group (n = 95), while 100 leukemia patients admitted during the same period were classified as the control group. Data were collected using Epidata 3.1 software, and comparisons were made between the two groups regarding general clinical data, the Piper Fatigue Scale (PFS), the Pittsburgh Sleep Quality Index (PSQI), the Numeric Rating Scale for pain assessment, laboratory indicators, and the occurrence of complications.
RESULTS: In this survey, 120 leukemia patients with depression were preliminarily screened, 95 patients with subthreshold depression were ultimately selected as the subthreshold depression group, and 100 leukemia patients admitted during the same period were enrolled as the normal group. Comparison of basic clinical data between the two groups revealed no significant differences in age, sex, body mass index, cognitive function, or comorbidity with other chronic diseases. However, there were statistically significant differences in the use of radiotherapy and regular exercise between the two groups (P < 0.05). Comparisons of scales and laboratory indicators revealed no significant differences in albumin or PSQI scores between the two groups, but there were statistically significant differences in pain scores, PSQI scores, PFS scores, hemoglobin levels, and C-reactive protein levels (P < 0.05). Spearman\'s correlation analysis indicated that cancer-related fatigue was correlated with age, hemoglobin levels, C-reactive protein levels, pain, and regular exercise among leukemia patients with subthreshold depression. Multivariate regression analysis revealed that advanced age, combined radiotherapy, pain, and low hemoglobin levels were risk factors for cancer-related fatigue in leukemia patients with comorbid subthreshold depression, while regular exercise was a protective factor against cancer-related fatigue. Follow-up comparisons revealed a significantly lower overall incidence of complications in the control group (4%) than in the depressive group (24.21%; P < 0.001).
CONCLUSIONS: Leukemia patients with comorbid subthreshold depressive symptoms experience more severe cancer-related fatigue and a higher incidence of complications. These findings may be related to advanced age, combined radiotherapy, pain, and low hemoglobin levels, while regular exercise may effectively alleviate symptoms.
摘要：
背景：患者不仅会经历癌症引起的症状，而且还会遭受伴随的心理痛苦。因此,这些患者的生活质量不高。根据世界卫生组织，2020年我国白血病发病率为5.1/100000,死亡率为3.3/100000,患病率为16.7/100000。因此,重要的是检查共病阈值下抑郁症状对白血病患者的影响。
目的：确定共病阈值下抑郁症状对白血病患者癌因性疲乏和并发症的影响，从而为临床早期诊断和治疗提供依据。
方法:对西安市某三级医院收治的白血病患者进行问卷调查,陕西省,中国,从2022年8月到2023年12月。中国精神障碍分类（CCMD-3）得分>16和汉密尔顿抑郁量表评分为8-17的患者被归类为阈值下抑郁组（n=95），同期收治的100例白血病患者被列为对照组。使用Epidata3.1软件收集数据，并对两组的一般临床资料进行比较,Piper疲劳量表（PFS），匹兹堡睡眠质量指数(PSQI)疼痛评估的数字评定量表，实验室指标,以及并发症的发生。
结果：在本次调查中，对120例白血病伴抑郁症患者进行初步筛查,最终选择95例阈下抑郁患者作为阈下抑郁组,同期收治的100例白血病患者作为正常组。两组患者的基本临床资料比较,年龄差异无统计学意义,性别,身体质量指数,认知功能,或与其他慢性疾病合并症。然而,两组患者在使用放疗和规律运动方面差异有统计学意义(P<0.05)。量表和实验室指标比较显示，两组间白蛋白或PSQI评分无显著差异。但是疼痛评分有统计学上的显著差异，PSQI得分,PFS分数,血红蛋白水平，C反应蛋白水平(P<0.05)。Spearman相关分析显示癌因性疲乏与年龄相关,血红蛋白水平，C反应蛋白水平,疼痛,并对患有亚阈值抑郁的白血病患者进行定期运动。多元回归分析显示，高龄，联合放疗，疼痛,低血红蛋白水平是白血病合并亚阈值抑郁患者癌因性疲乏的危险因素，而定期运动是预防癌症相关性疲劳的保护因素。随访比较显示，对照组的并发症总发生率（4％）明显低于抑郁组（24.21％；P<0.001）。
结论：伴有阈值下抑郁症状的白血病患者会经历更严重的癌症相关性疲劳和更高的并发症发生率。这些发现可能与高龄有关,联合放疗，疼痛,和低血红蛋白水平，而定期锻炼可以有效缓解症状。
目的：确定共病阈值下抑郁症状对白血病患者癌因性疲乏和并发症的影响，从而为临床早期诊断和治疗提供依据。
方法:对西安市某三级医院收治的白血病患者进行问卷调查,陕西省,中国,从2022年8月到2023年12月。中国精神障碍分类（CCMD-3）得分>16和汉密尔顿抑郁量表评分为8-17的患者被归类为阈值下抑郁组（n=95），同期收治的100例白血病患者被列为对照组。使用Epidata3.1软件收集数据，并对两组的一般临床资料进行比较,Piper疲劳量表（PFS），匹兹堡睡眠质量指数(PSQI)疼痛评估的数字评定量表，实验室指标,以及并发症的发生。
结果：在本次调查中，对120例白血病伴抑郁症患者进行初步筛查,最终选择95例阈下抑郁患者作为阈下抑郁组,同期收治的100例白血病患者作为正常组。两组患者的基本临床资料比较,年龄差异无统计学意义,性别,身体质量指数,认知功能,或与其他慢性疾病合并症。然而,两组患者在使用放疗和规律运动方面差异有统计学意义(P<0.05)。量表和实验室指标比较显示，两组间白蛋白或PSQI评分无显著差异。但是疼痛评分有统计学上的显著差异，PSQI得分,PFS分数,血红蛋白水平，C反应蛋白水平(P<0.05)。Spearman相关分析显示癌因性疲乏与年龄相关,血红蛋白水平，C反应蛋白水平,疼痛,并对患有亚阈值抑郁的白血病患者进行定期运动。多元回归分析显示，高龄，联合放疗，疼痛,低血红蛋白水平是白血病合并亚阈值抑郁患者癌因性疲乏的危险因素，而定期运动是预防癌症相关性疲劳的保护因素。随访比较显示，对照组的并发症总发生率（4％）明显低于抑郁组（24.21％；P<0.001）。
结论：伴有阈值下抑郁症状的白血病患者会经历更严重的癌症相关性疲劳和更高的并发症发生率。这些发现可能与高龄有关,联合放疗，疼痛,和低血红蛋白水平，而定期锻炼可以有效缓解症状。
