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Section 3. Medical psychology
https://doi.org/10.29013/ELBLS-20-4-37-39
Buruiana Sanda,
Associate Professor of the Department of Hematology SUMPh "Nicolae Testemitanu" Chisinau, Republic of Moldova
E-mail: sandaburuiana69@gmail.com
THE IMPORTANCE OF THE PSYHO-SPIRITUAL STATE OF PATIENTS WITH NON-HODGKIN'S LYMPHOMA
Abstract. Non-Hodgkin lymphomas (NHL) are a diverse group of neoplastic disorders, the incidence of which has shown a significant increase in rates over the year, worldwide, as well as in the Republic of Moldova. Is one of the most common hematological malignancies. Due to the efficient treatment methods, the rate of complete remissions increased and the patient's lifespan. The long time of monitoring involves special attention to the quality of life, especially the psychological and spiritual well-being of the patient with malignant lymphoma. Psycho-spiritual well-being is a subjective experience that incorporates both emotional health and meaning-in-life concerns. The psychological well-being was highlighted in the results of the GWB (Global Well Being) study group. The information obtained from the patient, from this questionnaire, although it is subjective, counts when making decisions in medical conduct and in the complex, subsequent recovery.
Keywords: lymphoma, well-being, quality of life.
1. Background negatively influence the quality of life, survival and
Non-Hodgkin lymphomas (NHL) are a diverse dysfunction of patients with NHL [6]. NHL patients group of neoplastic disorders, the incidence of which experience high levels of psychological distress dur-has shown a significant increase in rates over the year, ing intensive and long-term diagnosis and treatment worldwide, as well as in the Republic of Moldova [7; 8]. Secondary depression of the patient with on-[1]. Due to the efficient treatment methods, the rate cological disease, is manifested by persistent depres-of complete remissions increased and the patient's sive mood. Patients have a feeling of insecurity, regret life expectancy and lifespan [2; 3]. The response to that they got sick and no longer have the opportu-treatment and patient survival did not reflect data nity to do the things, the activities they could have about psychological and emotional well-being of the done before [9]. The general clinical psychic mani-patient with NHL [3; 4]. Psycho-spiritual well-be- festations of depression are: malaise, pessimism, de-ing is a subjective experience that incorporates both creased libido, lack of appetite, inactivity, inability to emotional health and meaning-in-life concerns [5]. concentrate, frequent thoughts about death, suicidal Anxiety, depression, disease-related stress, coping tendencies [9]. The general somatic clinical mani-strategies and optimism they are risk factors, which festations of depression are: insomnia, irritability,
Section 3. Medical psychology
weight loss [9; 10]. The anxiety of cancer patients is manifested by: fear, fear of death, insecurity of the disease, fear of not being able to control pain, fear of disabilities that create dependence on others, fear of changing appearance [9; 10].
The quality of life of a lymphoma patient can be influenced by the choice of the type of treatment, but also by the implementation of rehabilitation measures [8; 11].
2. Study methods
The study included 66 patients with the diagnosis of NHL: 37 patients with aggressive NHL and 29 patients with indolent NHL, who have met the criteria for inclusion in the study. The psycho-spiritual well-being of patients with NHL was assessed on the basis of the patient's independent completion of the GWB (general psychological well-being index) questionnaire. Patients answered 18 questions with 6 answer options, which reflect 6 basic parameters: anxiety, depression, general health, self, vitality and wellbeing. Each answer has 6 options (0-5), both negative and positive. This questionnaire reflects only the patient's subjective feelings about his own suffering and psychological well-being. The average time required to complete the questionnaire was approximately 7-10 minutes.
3. Results
Patients with NHL included in the study, treated in the Hematology Department of PMSI IO (Public Medico-Sanitary Institution Oncological Institute, Chisinau, Republic of Moldova), had a mean age of 58.3 ± 1.3 years (32-78 years). Women accounted for 53% (35 patients) and men - 47% (31 patients).
The results of the analysis of the psychological suffering of the NHLs patients, depending on the age, find a severe psychological suffering at the stage of establishing the diagnosis, regardless of age. Medium stress and good psychological well-being were more common in patients over 50 years of age (11% and 14%, respectively).
Following the analysis of the obtained results, we can mention the predominance of severe psychologi-
cal distress in all types of NHL with a predominance in aggressive lymphomas (64%). Good psychological condition predominated in patients with indolent NHL (26%), as opposed to patients with aggressive NHL (17%). This could be explained by the fact that indolent NHL is characterized by slow progressive progression, prolonged lack ofsigns ofgeneral intoxication that would affect the quality oflife, but aggressive NHL has a rapid evolution, but with a high sensitivity to chemotherapy with lasting complete remissions.
Severe psychological distress was determined by the predominance of anxiety, depression, psychological tension especially in women (73%). This could be explained by the fact that in today's society, women's roles often include family obligations, care-giving for children and/or elderly parent and work responsibilities as well as other roles. They may feel a sense of failure in not being able to meet expectations for themselves and others.
I found that patients with NHL are subjected to high levels of psychological distress during diagnosis and treatment regardless of the degree of spread of the tumor process. The diagnosis of NHL conditions psycho-spiritual changes, due to discomfort, pain, aesthetic changes, interruption of professional activity, lifestyle changes, both the patient and his family. In patients with localized process (I and II stages) good psychological state was manifested in 50% of cases, and in patients with generalized process (stage IV), in 64% of cases, severe psychological suffering was highlighted.
4. Conclusion
Severe psycho-emotional suffering is characteristic of all patients, regardless of age, with malignant lymphoma at the stage of establishing the diagnosis, especially in aggressive lymphomas (64%). Regardless of the morphological type of NHL (aggressive or indolent) in 73% of cases, women developed severe psychological stress. Good psychological well-being was manifested in 50% of patients with stage I of NHL, and in 64% patients in stage IV severe psychological suffering was highlighted. Assessing patient's
psycho-spiritual changes will allow us to individually The basic goal is that we treat not only cancer, but a
select specific and nonspecific treatment behaviors. patient with cancer.
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