Interplay Between Psychological Burden, Economic Stress, and Quality of Life in Chronic Myeloid Leukemia Care: An Integrated Analysis.

Abstract

As survival rates among patients with chronic myeloid leukemia (CML) have improved significantly, treatment goals have expanded from disease control to optimizing long-term quality of life (QoL). The multicenter cross-sectional study used relevant survey questionnaires to gather comprehensive data on baseline characteristics, clinical treatment, economic burdens, psychological status, adverse events (AEs), and QoL among patients with CML. In all, 2,035 valid questionnaires were included for analysis. Psychological burden assessments indicate a high prevalence of mental health symptoms: 38.5% of patients report experiencing anxiety symptoms, whereas 46% exhibit symptoms of depression. This study identified a high-burden group experiencing significant economic and psychological stressors, which are associated with poor clinical responses. Psychological burden is central to the psychosocial clinical network and exhibits the strongest correlation with QoL (<i>r</i> = 0.64). Notably, the mediation model indicates that psychological burden fully mediates the effect of economic burden on QoL (85.3%) and partially mediates its influence on medication adherence (35.5%). Furthermore, we identified a clinically significant subgroup characterized as QoL lag-patients who achieve deep molecular response but report low QoL. This discrepancy is independently predicted by multiple AEs (≥6 types: OR = 2.09), serious AEs (OR = 1.90), comorbidities (OR = 2.44), and escalating psychological burden (OR = 1.59). The findings underscore the need to shift the treatment of CML toward a holistic management paradigm. Clinical practice must actively engage with patients' concerns to optimize treatment efficacy, adjust drug dosages appropriately, and integrate social resources to provide psychological, economic, and familial support.