Approach-Oriented Coping May Improve Quality-of-Life Outcomes in Acute Myeloid Leukemia


Findings from a secondary analysis highlighted an association between improved quality of life outcomes and longitudinal use of approach-oriented coping strategies in patients with acute myeloid leukemia.

Longitudinal use of approach-oriented coping strategies was associated with fewer distress symptoms, quality of life (QOL), and health care outcomes for patients with acute myeloid leukemia (AML), while avoidant strategies were associated with worse outcomes, according to data from a secondary analysis published in the Journal of the National Comprehensive Cancer Network.

Investigators found that approach-oriented coping strategies were significantly associated with reduced anxiety (β, –0.18; 95% CI, –0.25 to –0.12; P <.001), risk of depression (β, –0.42; 95% CI, –0.49 to –0.35; P <.001) and post-traumatic stress disorder (PTSD) symptoms (β, –0.60; 95% CI, –0.77 to –0.43l P <.100), and better QOL (β, 2.00; 95% CI, 1.59-2.42; P <.001). The opposite was true for avoidant strategies, which were associated with greater anxiety (β, 0.64; 95% CI, 0.49-0.78; P <.001), a heightened risk of depression (β, 0.64; 95% CI, 0.49-0.78; P <.001) and PTSD symptoms (β, 2.13; 95% CI, 1.77-2.49; P <.001 for both), and worse QOL (β, –4.27; 95% CI, –5.14 to –3.40; P <.001). Approach-oriented strategies were also associated with lower odds of ICU admission (odds ratio [OR], 0.92; 95% CI, 0.841-0.999; P =.049) in the last 30 days before death, although no similar association was noted with rates of hospitalization, chemotherapy administration, or hospice use in the same period.

“Our study shows that for patients with high-risk AML, the longitudinal use of approach-oriented coping is associated with fewer symptoms of distress, better QOL, and lower odds of ICU admission,” the investigators wrote. “Hence, cultivating approach-oriented coping via supportive oncology interventions in the early phases of the illness experience of patients with high-risk AML could yield immediate and long-term benefits over the course of their illness, treatment, and recovery.”

To measure coping strategies, psychological distress and QOL at baseline as well as at weeks 2, 4, 12, and 24 after diagnosis, investigators employed the Brief-COPE questionnaire, the Hospital Anxiety and Depression Scale, the civilian version of the PTSD Checklist, and the Functional Assessment of Cancer Therapy–Leukemia. They assessed health care use and end of life (EOL) outcomes through examination of electronic health records and evaluation of the relationship between outcomes and coping strategy using multivariate analyses. A suite of 7 coping strategies was was categorized as being approach-oriented or avoidant categories based on prior literature using an aggregate of individual domain scores. Approach-oriented coping included the use of emotional support, active coping, positive reframing, and acceptance, while avoidant coping included self-blame, denial, and behavioral disengagement.

The analysis included 235 patients with AML, of whom 160 enrolled in a supportive care intervention trial (NCT02207322). Most patients had newly diagnosed AML (68.1%) while others had relapsed AML (23.1%) and refractory AML (8.8%). Most patients were non-Hispanic White (86.3%), most were men (60.0%), and most were married (73.8%). The population had a median age of 64.4 years (range, 19.7-80.1), and a plurality (45.0%) of patients were college-educated.

Although use of both strategies declined over time in the patient population, the proportion of those who reported high use of approach-oriented coping declined consistently, from 47.5% at baseline, to 40.6% at week 2, 33.1% at week 4, 30.0% at week 12, and 24.4% at week 24. However, the proportion of participants who reported high use of avoidant coping increased during the first month (baseline, 33.1%; week 2, 38.8%; week 4, 40.0%) and then declined at 12 weeks (30.0%) and 24 weeks (21.2%). The analysis found no significant association between sociodemographic factors such as age, sex, race, or income and high use of either set of coping strategies; the same was true of disease factors.

The median number of days alive and out of hospital (DAOH) in the study cohort was 119.5 days (range, 97.5-154.5). Forty-six patients were admitted to the ICU and 84 died during the study period. Among the deceased, 30 used hospice and 42 received chemotherapy in the last 30 days of life. Aside from the reduced ICU usage observed in patients using approach-oriented strategies, neither set of coping strategies was associated with DAOH or EOL outcomes.

“Given the heterogeneity of the clinical course and treatments for patients with AML, our sample size was likely inadequate to explore the relationship between clinical course and coping strategies,” the investigators concluded. “Nonetheless, these findings underscore the need for future studies to explore how coping evolves and the relationship between clinical course and coping strategies. Such research would inform the development of well-timed supportive interventions for maximum impact in the AML population.”


Amonoo HL, Daskalakis E, Deary EC, et al. Relationship between longitudinal coping strategies and outcomes in patients with acute myeloid leukemia. J Natl Compr Canc Netw. 2022;20(10):1116-1123. doi:10.6004/jnccn.2022.7045

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