To compare the anxiety, depression and explore their relationship to quality of life (QoL) among adult acute leukemia (AL) patients and family caregivers (FCs) in China.
A multicenter cross-sectional study was conducted from April 2017 to January 2018. The sample comprised 207 dyads of adult AL patients and FCs. The participants were required to complete socio-demographic information and the Hospital Anxiety and Depression Scale (HADS). The Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu, only for patients) and MOS 36-item Short-Form Health Survey (SF-36, only for FCs) were used to measure QoL.
The mean scores of anxiety and depression for AL patients were 7.89 ± 3.85 and 7.18 ± 4.23, respectively. For FCs, the mean scores of anxiety and depression were 9.96 ± 3.73 and 8.64 ± 3.74. In this study, adult AL Patients’ sex, patients’ depression score, whether patients achieving a CR or not, education, FCs’ depression score, patients’ social/family well-being and emotional well-being were significantly associated with patients’ anxiety or depression (p < 0.05). For FCs, depression was significantly related to the physical component summary (β = 0.127, p = 0.008). There were significant differences in anxiety (t = − 5.92, p < 0.001) and depression (t = − 4.19, p < 0.001) between patients and FCs.
AL patients’ FCs showed higher score of anxiety and depression than that of patients. The psychological health may have a potential relationship between AL patients and their FCs. Healthcare professionals can conduct family-center interventions to improve mental health and QoL of AL patients and FCs.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Acute lymphocytic leukemia
Acute myeloid leukemia
The Hospital Anxiety and Depression Scale
Anxiety subscale of HADS
Depression subscale of HADS
The leukemia-specific subscale
Physical component summary
Quality of life
Social/family well-being domain
Juliusson, G., & Hough, R. (2016). Leukemia. Progress in Tumor Research, 43, 87–100.
Chen, W., Zheng, R., Baade, P. D., Zhang, S., Zeng, H., Bray, F., et al. (2016). Cancer statistics in China, 2015. CA: A Cancer Journal for Clinicians, 66(2), 115–132.
Albrecht, T. A. (2014). Physiologic and psychological symptoms experienced by adults with acute leukemia: An integrative literature review. Oncology Nursing Forum, 41(3), 286–295.
Wang, J., Shen, N., Zhang, X., Shen, M., Xie, A., Howell, D., et al. (2017). Care burden and its predictive factors in parents of newly diagnosed children with acute lymphoblastic leukemia in academic hospitals in China. Supportive Care in Cancer, 25(12), 3703–3713.
Sabine Kayser, R. F. S., Grimwade, D., Yosuico, V. E. D., & Walter, R. B. (2015). Minimal residual disease–directed therapy in acute myeloid leukemia. Blood, 125, 2331–2335.
Leak Bryant, A., Walton, A. L., Pergolotti, M., Phillips, B., Bailey, C., Mayer, D. K., et al. (2017). Perceived benefits and barriers to exercise for recently treated adults with acute leukemia. Oncology Nursing Forum, 44(4), 413–420.
Meng, Q., Yang, Z., Wu, Y., Xiao, Y., Gu, X., Zhang, M., et al. (2017). Reliability analysis of the Chinese version of the Functional Assessment of Cancer Therapy - Leukemia (FACT-Leu) scale based on multivariate generalizability theory. Health and Quality of Life Outcomes, 15(1), 93.
Alexander, G., Bebee, C. E., Chen, K. M., Vignes, R. D., Dixon, B., Escoffery, R., et al. (2016). Burden of caregivers of adult patients with schizophrenia in a predominantly African ancestry population. Quality of Life Research, 25(2), 393–400.
Cella, D., Jensen, S. E., Webster, K., Hongyan, D., Lai, J. S., Rosen, S., et al. (2012). Measuring health-related quality of life in Leukemia: The Functional Assessment of Cancer Therapy—Leukemia (FACT-Leu) Questionnaire. Value in Health, 15(8), 1051–1058.
Stenberg, U., Ruland, C. M., & Miaskowski, C. (2010). Review of the literature on the effects of caring for a patient with cancer. Psychooncology, 19(10), 1013–1025.
Wang, C., Yan, J., Chen, J., Wang, Y., Lin, Y. C., Hu, R., et al. (2020). Factors associated with quality of life of adult patients with acute leukemia and their family caregivers in China: A cross-sectional study. Health and Quality of Life Outcomes, 18(1), 8.
Beck, K. R., Tan, S. M., Lum, S. S., Lim, L. E., & Krishna, L. K. (2016). Validation of the emotion thermometers and hospital anxiety and depression scales in Singapore: Screening cancer patients for distress, anxiety and depression. Asia-Pacific Journal of Clinical Oncology, 12(2), e241–e249.
Romito, F., Goldzweig, G., Cormio, C., Hagedoorn, M., & Andersen, B. L. (2013). Informal caregiving for cancer patients. Cancer, 119(Suppl 11), 2160–2169.
Northouse, L., Williams, A. L., Given, B., & McCorkle, R. (2012). Psychosocial care for family caregivers of patients with cancer. Journal of Clinical Oncology, 30(11), 1227–1234.
Kim, Y., Kashy, D. A., Wellisch, D. K., Spillers, R. L., & Smith, T. G. (2008). Quality of life of couples dealing with cancer: Dyadic and individual adjustment among breast and prostate cancer survivors and their spousal caregivers. Annals of Behavioral Medicine, 35, 230.
Dellafiore, F., Chung, M. L., Alvaro, R., Durante, A., Colaceci, S., Vellone, E., et al. (2019). The association between mutuality, anxiety, and depression in heart failure patient-caregiver dyads: An actor-partner interdependence model analysis. Journal of Cardiovascular Nursing, 34(6), 465–473.
Chung, M. L., Moser, D. K., Lennie, T. A., & Rayens, M. K. (2009). The effects of depressive symptoms and anxiety on quality of life in patients with heart failure and their spouses: Testing dyadic dynamics using actor-partner interdependence model. Journal of psychosomatic research, 67(1), 29.
Wan-Fei, K., Syed Hassan, S. T., Munn Sann, L., Fadhilah Ismail, S. I., Abdul Raman, R., & Ibrahim, F. (2017). Depression, anxiety and quality of life in stroke survivors and their family caregivers: A pilot study using an actor/partner interdependence model. Electronic Physician, 9(8), 4924–4933.
Monika, J. R., Kerenaftali, K., O’Connell, D. L., Helen, G., David, G., Merrett, N. D., et al. (2017). Anxiety, depression and quality of life in chronic obstructive pulmonary disease patients and caregivers an actor-partner interdependence model analysis. Quality of Life Research, 28, 461.
Nyamathi, A. (2010). Comprehensive health seeking and coping paradigm. Journal of Advanced Nursing., 14(4), 281–290.
Saria, M. G., Courchesne, N. S., Evangelista, L., Carter, J. L., MacManus, D. A., Gorman, M. K., et al. (2017). Anxiety and depression associated with burden in caregivers of patients with brain metastases. Oncology Nursing Forum, 44(3), 306–315.
Ingvar Bjelland, A. A. D., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale An updated literature review. Journal of Psychosomatic Research, 52, 69–77.
Lee, Y. H., Liao, Y. C., Liao, W. Y., Shun, S. C., Liu, Y. C., Chan, J. C., et al. (2013). Anxiety, depression and related factors in family caregivers of newly diagnosed lung cancer patients before first treatment. Psychooncology, 22(11), 2617–2623.
Hartung, T. J., Friedrich, M., Johansen, C., Wittchen, H. U., Faller, H., Koch, U., et al. (2017). The Hospital Anxiety and Depression Scale (HADS) and the 9-item Patient Health Questionnaire (PHQ-9) as screening instruments for depression in patients with cancer. Cancer, 123(21), 4236–4243.
Temiz, G., & Durna, Z. (2019). Evaluation of quality of life and health care needs in cancer patients receiving chemotherapy. Journal of Cancer Education, 35, 796.
Lam, C. L., Tse, E. Y., Gandek, B., & Fong, D. Y. (2005). The SF-36 summary scales were valid, reliable, and equivalent in a Chinese population. Journal of Clinical Epidemiology, 58(8), 815–822.
Ho, R. C. M., Fu, E. H. Y., Chua, A. N. C., Cheak, A. A. C., & Mak, A. (2011). Clinical and psychosocial factors associated with depression and anxiety in Singaporean patients with rheumatoid arthritis. International Journal of Rheumatic Diseases, 14(1), 37–47.
Ho, R. C. M., Giam, Y., Ng, T. P., Mak, A., Goh, D., Zhang, M. W. B., et al. (2010). The influence of childhood atopic dermatitis on health of mothers, and its impact on Asian families. Pediatric Allergy & Immunology, 21(3), 501–507.
Xie, H., Cheng, C., Tao, Y., Zhang, J., Robert, D., Jia, J., et al. (2016). Quality of life in Chinese family caregivers for elderly people with chronic diseases. Health and Quality of Life Outcomes, 14(1), 99.
Pereira, M. G., Vilaca, M., Pereira, M., Ferreira, G., Monteiro, S., Coelho, H., et al. (2020). The mediator role of unmet needs on quality of life in myeloma patients. Quality of Life Research, 29(10), 2641–2650.
Smith, A. B., Selby, P. J., Velikova, G., Stark, D., Wright, E. P., Gould, A., & Cull, A. (2002). Factor analysis of the Hospital Anxiety and Depression Scale from a large cancer population. Psychology and Psychotherapy, 75, 165–1761.
Rodin, G., Deckert, A., Tong, E., Le, L. W., Rydall, A., Schimmer, A., et al. (2018). Traumatic stress in patients with acute leukemia: A prospective cohort study. Psychooncology, 27(2), 515–523.
Janda, M., Neale, R. E., Klein, K., O’Connell, D. L., Gooden, H., Goldstein, D., et al. (2017). Anxiety, depression and quality of life in people with pancreatic cancer and their carers. Pancreatology, 17(2), 321–327.
Jeong, A., Shin, D. W., Kim, S. Y., Yang, H. K., & Park, J. H. (2016). Avoidance of cancer communication, perceived social support, and anxiety and depression among patients with cancer. Psychooncology., 25(11), 1301–1307.
Ivziku, D., Clari, M., Piredda, M., De Marinis, M. G., & Matarese, M. (2019). Anxiety, depression and quality of life in chronic obstructive pulmonary disease patients and caregivers: An actor-partner interdependence model analysis. Quality of Life Research, 28(2), 461–472.
Kim, Y., Carver, C. S., Spillers, R. L., Crammer, C., & Zhou, E. S. (2011). Individual and dyadic relations between spiritual well-being and quality of life among cancer survivors and their spousal caregivers. Psychooncology, 20(7), 762–770.
Gough, K., & Hudson, P. (2009). Psychometric properties of the Hospital Anxiety and Depression Scale in family caregivers of palliative care patients. Journal of Pain and Symptom Management, 37(5), 797–806.
Shin, J. Y., Lim, J. W., Shin, D. W., Kim, S. Y., Yang, H. K., Cho, J., et al. (2017). Underestimated caregiver burden by cancer patients and its association with quality of life, depression and anxiety among caregivers. The European Journal of Cancer Care, 27, e12814.
Lin, C. R., Chen, S. C., Simard, S., Chang, T. C., & Lai, Y. H. (2018). Psychometric testing of the fear of cancer recurrence inventory- caregiver chinese version in cancer family caregivers in Taiwan. Psycho-Oncology, 27, 1580.
Kim, Y., Van Ryn, M., Rowland, J., et al. (2015). Effects of gender and depressive symptoms on quality of life among colorectal and lung cancer patients and their family caregivers. Psycho Oncology, 24, 95.
Segrin, C., Badger, T. A., & Harrington, J. (2012). Interdependent psychological quality of life in dyads adjusting to prostate cancer. Health Psychology Official Journal of the Division of Health Psychology American Psychological Association, 31(1), 70–79.
Girgis, A., & Lambert, S. (2009). Caregivers of cancer survivors: The state of the field | NOVA. The University of Newcastle’s Digital Repository. Construction & Building Materials, 23(6), 2196–2206.
Li, Q., Lin, Y., Qiu, Y., Gao, B., & Xu, Y. (2014). The assessment of health-related quality of life and related factors in Chinese elderly patients undergoing chemotherapy for advanced cancer: A cross-sectional study. European Journal of Oncology Nursing the Official Journal of European Oncology Nursing Society, 18(4), 425–435.
Getu, M. A., Chen, C., Panpan, W., Mboineki, J. F., Dhakal, K., & Du, R. (2020). The effect of cognitive behavioral therapy on the quality of life of breast cancer patients: A systematic review and meta-analysis of randomized controlled trials. Quality of Life Research. https://doi.org/10.1007/s11136-020-02665-5.
Friðriksdóttir, N., Sævarsdóttir, Þ, Halfdanardottir, S. I., Jonsdottir, A., Magnúsdóttir, H., Olafsdottir, K. L., et al. (2011). Family members of cancer patients: Needs, quality of life and symptoms of anxiety and depression. Acta Oncologica, 50, 250.
Joseph, R. W., Liu, F. X., Shillington, A. C., Macahilig, C. P., Diede, S. J., Dave, V., et al. (2020). Health-related quality of life (QoL) in patients with advanced melanoma receiving immunotherapies in real-world clinical practice settings. Quality of Life Research, 29(10), 2651–2660.
Linden, W., Vodermaier, A., Mackenzie, R., & Greig, D. (2012). Anxiety and depression after cancer diagnosis: Prevalence rates by cancer type, gender, and age. Journal of Affective Disorders, 141(2–3), 343–351.
Hinz, A., Herzberg, P. Y., Lordick, F., Weis, J., & Mehnert, A. (2019). Age and gender differences in anxiety and depression in cancer patients compared with the general population. European Journal of Cancer Care, 28(7), e13129.
Cardoso, G., Graca, J., Klut, C., Trancas, B., & Papoila, A. (2016). Depression and anxiety symptoms following cancer diagnosis: A cross-sectional study. Psychology, Health & Medicine, 21(5), 562–570.
Ding, T., Wang, X., Fu, A., Xu, L., & Lin, J. (2019). Anxiety and depression predict unfavorable survival in acute myeloid leukemia patients. Medicine (Baltimore), 98(43), e17314.
Gu, M., Hao, X., Cong, L., & Sun, J. (2019). The prevalence, risk factors, and prognostic value of anxiety and depression in refractory or relapsed acute myeloid leukemia patients of North China. Medicine (Baltimore), 98(50), e18196.
Isidori, A., Loscocco, F., & Visani, G. (2016). AML therapy in the elderly: A time for a change. Expert Opinion on Drug Safety, 15(7), 891–892.
The authors are especially grateful to Hairong Zhang for his kind help in statistics. The authors gratefully thank the support from the related hospitals and all the participants for their contribution in this study. The authors have full control of all primary data and agree to allow the journal to review the data, if necessary. The authors thank the Scientific Research Talents Training Project from the Fujian Province Health Commission (Grant No. 2018-ZQN-63) and Nature Science Foundation of Fujian Provincial (Grant No. 2019J01684).
This study was supported by the Scientific Research Talents Training Project from the Fujian Province Health Commission (Grant No. 2018-ZQN-63) and Nature Science Foundation of Fujian Provincial (Grant No. 2019J01684).
Conflict of interest
The authors have no funding or conflicts of interest to disclose.
The study was approved by the Biological and Medical Research Ethics Committee of Fujian Medical university (IRB Ref No: 2017/00049) in September 2017. No study procedures were performed before subjects signed informed consent forms.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Below is the link to the electronic supplementary material.
About this article
Cite this article
Wang, Y., Yan, J., Chen, J. et al. Comparison of the anxiety, depression and their relationship to quality of life among adult acute leukemia patients and their family caregivers: a cross-sectional study in China. Qual Life Res (2021). https://doi.org/10.1007/s11136-021-02785-6
- Quality of life
- Family caregiver