Original Article

Association between Perceived Stress and Neutropenia in Patients with Leukemia under Chemotherapy

Abstract

 

Background: The most prominent part of the cellular response of the immune system is driven by neutrophils. These cells tend to decline following chemotherapy in patients with leukemia. Neutropenia is an influential factor in the prognosis of cancer patients. Stress reduces white blood cells (WBC) and neutrophils are linked to an increased risk of infectious diseases after chemotherapy. We investigated the association between neutropenia and perceived stress following chemotherapy.

Materials and Methods: We performed a cross-sectional study on 60 patients with leukemia in a university hospital. Participants completed self-report measures including the demographic data and perceived stress scale (PSS) questionnaire.

We compared rates of neutropenia, as a measure of chemotherapy prognosis, 10 days after chemotherapy in different stress levels. Moreover, the number of patients with polymorphonuclear (PMN) under 1000/microl was compared at different stress levels.   

Results: We found that neutropenia is directly correlated with negative stress perception and inversely correlated with positive stress perception. These effects appear more prominent in patients with PMN under 1000/microl as the number of these patients was significantly more in groups with higher negative stress and less in groups with higher positive stress scores.

Conclusion: It can be concluded that stress is correlated with neutropenia and stress management in patients with leukemia will be accompanied by better recovery outcomes and reduced risk of infectious disease.

 

1. Mokdad AH, Dwyer-Lindgren L , Fitzmaurice C, et al. Trends and patterns of disparities in cancer mortality among US counties, 1980-2014. JAMA. 2017;317(4):388-406.
2. Chen Y, Wang H, Kantarjian H, et al. Trends in chronic myeloid leukemia incidence and survival in the United States from 1975 to 2009. Leuk Lymphoma. 2013; 54(7): 1411–1417.
3. Swords R, Sznol J , Elias R, et al. Acute leukemia in adult Hispanic Americans: a large population study. Blood Cancer J. 2016; 6(10):e484.
4. Kantarjian HM, Talpaz M, Giles F, et al. New insights into the pathophysiology of chronic myeloid leukemia and imatinib resistance. Ann Intern Med. 2006; 145(12):913-23.
5. Randolph TR. Acute promyelocytic leukemia (AML-M3)-part 1: Pathophysiology, clinical diagnosis, and differentiation therapy. Clin Lab Sci.2000;13(2):98-105.
6. Rodin G, Yuen D, Mischitelle A, et al. Traumatic stress in acute leukemia. Psychooncology. 2013; 22(2):299-307.
7. Mazevet M, Moulin M, Llach-Martinez A, et al. Complications of chemotherapy, a basic science update. Presse Med. 2013; 42(9 Pt 2):e352-61.
8. Verstappen CCP, Heimans JJ, Hoekman K, et al. Neurotoxic complications of chemotherapy in patients with cancer. Drugs . 2003;63(15): 1549-63.
9. Crawford JN, Dale DC, GH Lyman. Chemotherapy‐induced neutropenia. Risks, consequences, and new directions for its management.Cancer. 2004;100(2):228-37.
10. Ader R, Friedman SB. Social Factors Affecting Emotionality and Resistance to Disease in Animals. V. Early Separation from the Mother and Response to a Transplanted Tumor in the Rat. Psychosom Med. 1965; 27:119-22.
11. ADER R. Social factors affecting emotionality and resistance to disease in animals: III. Early weaning and susceptibility to gastric ulcers in the rat. A control for nutritional factors. J Comp Physiol Psychol. 1962; 55:600-2.
12. Silverman MN , Pearce BD , Biron CA, et al. Immune modulation of the hypothalamic-pituitary-adrenal (HPA) axis during viral infection. Viral Immunol. 2005;18(1):41-78.
13. Savastano S, Tommaselli AP, Valentino R, et al. Hypothalamic-pituitary-adrenal axis and immune system. Acta Neurol (Napoli).1994;16(4):206-13.
14. Pongratz G, Straub RH.The sympathetic nervous response in inflammation. Arthritis Res Ther.2014;16(6):504.
15. De Vito P, Incerpi S, Pedersen JZ, et al. Thyroid hormones as modulators of immune activities at the cellular level. Thyroid.2011;21(8):879-90.
16. Rosas-Ballina M, Tracey KJ. Cholinergic control of inflammation. J Intern Med . 2009;265(6):663-79.
17. Haghshomar M, Rahmani F, Aarabi MH, et al. White Matter Changes Correlates of Peripheral Neuroinflammation in Patients with Parkinson’s Disease. Neuroscience. 2019;403:70-78.
18. Besedovsky OH, del Rey A. Immune-neuro-endocrine interactions: facts and hypotheses. Endocr Rev. 1996; 17(1):64-102.
19. Moreno-Smith M, Lutgendorf SK, Sood AK.Impact of stress on cancer metastasis. Future Oncol .2010;6(12):1863-81.
20. Tsukamoto K , Machida K .Effects of life events and stress on neutrophil functions in elderly men . Immun. Ageing.2012;9(1):13.
21. Donaldson VW. A clinical study of visualization on depressed white blood cell count in medical patients. Appl Psychophysiol Biofeedback. 2000; 25(2):117-28.
22. McGregor BA, Antoni MH, Boyers A, et al. Cognitive-behavioral stress management increases benefit finding and immune function among women with early-stage breast cancer. J Psychosom Res. 2004;56(1):1-8.
23. Cohen S, Kamarck T, Mermelstein R. Perceived stress scale. Meas Stress A Guide Heal Soc Sci. 1994;10(2):1-2.
24. Lee EH.Review of the Psychometric Evidence of the Perceived Stress Scale. Asian Nurs Res (Korean Soc Nurs Sci). 2012;6(4):121-7
25. Hansen BA, Wendelbo O, Bruserud O, et al. Febrile Neutropenia in Acute Leukemia. Epidemiology, Etiology, Pathophysiology, and Treatment. Mediterr J Hematol Infect Dis. 2020;12(1):e2020009.
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IssueVol 16, No 2 (2022) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijhoscr.v16i2.9203
Keywords
Neutropenia; Chemotherapy; Stress perception
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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Esfandbod M, Tehrani M, Haghshomar M, Arya P, Shateri Amiri B, Toogeh G, Keyhani M. Association between Perceived Stress and Neutropenia in Patients with Leukemia under Chemotherapy. Int J Hematol Oncol Stem Cell Res. 2022;16(2):103-109.