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Alert Number 298

A Good Day to Talk about Depression

Date: September 29, 2008

Today seems to be a good day to talk about depression.

The attached article from Reuters today talks about the risks of depression in patients who have suffered a heart attack. 

Do you think newly diagnosed CLL patients are depressed?  What percentage of them “buy” the cliché that CLL is “the good cancer to have”?  If you believe the results of the very large online patient survey Mayo Clinic conducted in partnership with CLL Topics, very few patients are reassured by this flippant phrase – on the contrary, it significantly decreases patients’ confidence in the doctor that uses that particular approach.  I have attached below our Alert #253 that reported on the results of the Quality of Life survey we did.

Depression hurts in many ways. As in the heart patient study cited here, depression makes it harder for patients to stick to a regimen of good diet, exercise, making and keeping medical appointments, the list is quite long.  Anecdotally I know of many CLL patients whose efforts to quit smoking ended in failure because in their depressed state they just could not muster the will power to do so.  In case you have forgotten, lung cancer occurs more frequently in CLL patients, compared to the general population.  Obesity related diseases such as diabetes, hypertension, high cholesterol etc are significant complications that can complicate CLL therapies.

There is one further reason why depression is particularly important issue in CLL patients.  Unlike short fuse cancers such as pancreatic cancer and lung cancer, CLL can smolder for many years.  I keep telling our people they should be prepared for a long marathon with this sucker, not a short sprint.  For many “Type A” personalities out there the concept of “Watch & Wait” is slow torture.  Nevertheless, it is absolutely important that you recognize the importance of making rational therapy decisions, over the long haul.  Depression surely gets in the way of doing that.

Last but not least, even if you get no breaks and your overall survival is exactly what one would expect from median expectancy estimates, do you want to spend how ever many years you have with a black cloud hovering over your head?  If you are looking for a quick resolution, an up or down vote that sorts things out one way of the other darn it, CLL is not going to oblige you.  Some one said to me CLL is a death of a thousand cuts – I prefer to think of it as life of many thousand days.

Life is for the living.  Sooner or later, all of us will die – the trick is to have happy and meaningful lives while we are still here to enjoy the sunshine.  If depression because of your recent CLL diagnosis is robbing you of joy and vitality just when you need them most, please do yourself a favor – don’t underestimate the negative power of depression, seek medical help, seek spiritual help, seek whatever type of help that works for you.  (Before you guys jump on me, I will be the first one to admit I am much better at handing out advice than I am at taking it myself.  An honest self assessment forces me to confess I am a significantly over weight, diabetic and depressed internet potato – better than couch potato, I guess).

Be well,



Guidelines alert heart patients to depression risk

Mon Sep 29, 2008 4:22pm EDT

By Julie Steenhuysen

CHICAGO (Reuters) - Heart patients should be screened routinely for depression, a common complication that can make a second heart attack more likely, according to guidelines released by the American Heart Association on Monday.

They reflect growing evidence that depression often follows a heart attack, and depressed heart patients are at higher risk for more heart trouble.

"Studies show that depression is about three times more common in patients following a heart attack than in the general community," said Judith Lichtman of Yale University School of Medicine, who helped write the new guidelines, which appear in the journal Circulation.

"Because there has been no routine screening for depression in heart patients, we think there is a large group of people who could benefit from appropriate treatment," she said in a statement.

Lichtman said more research is needed to understand why heart patients are more likely to be depressed.

For Barbara Forman of Dayton, Ohio, depression set in shortly after her double bypass surgery 5 years ago. "I had the idea that I would be an invalid for the rest of my life," she said in a telephone interview.

Forman believes the heart disease triggered her depression. She got help from medication, and now volunteers for Mended Hearts, a support group.

Getting help may save lives, Lichtman said. Studies show depressed heart patients are more likely than others to stop taking their heart medications and are less likely to stay on heart-healthy diets or get regular exercise.

Depression can also bring about changes in the body, including reduced heart rate and increases in blood factors that encourage the formation of blood clots.

The group recommends early and repeated screenings for depression. Heart patients showing signs of depression should be evaluated by a mental health professional and screened for other psychiatric disorders, such as anxiety.

Treatment options might include therapy, exercise, antidepressants, cardiac rehabilitation or a combination of these approaches.

(Editing by Maggie Fox and Jackie Frank)



TOPICS ALERT Number: 253

Date: September 29, 2007

Remember that Quality of Life survey that we bugged you to fill out a while back? Well, finally we have some results from that study. A whopping 1482 patients took that survey and the vast majority Ė more than 95% of them - were from CLL Topics members. The survey is a first of its kind by a major research institution (Mayo Clinic, Rochester MN), and it was possible only because of our ability to mobilize patients. Take a bow, you guys. You did us proud.

This article is the first of several articles that will be published in the months to come, as well as presentations at various conferences etc. It seems journals donít like publishing long articles, hence the need to slice the results into several smaller articles. I guess it also does not hurt to have a long list of publications for the authors. Ahem. I am one of the authors. But since I am a retired oil patch chemical engineer, I donít particularly care how many oncology articles are on my list of publications. After a few more of these articles have been published, I will do a full length review of the findings on

Some of the findings of this study will seem obvious to you. And well they should, since your responses were what drove the findings! I donít have a full text PDF of the article yet, but I expect I will, soon. Write to me if you want to read the full article and see what the patient community had to say about living with CLL.

Be well,


Br J Haematol. 2007 Oct;139(2):255-64.

Quality of life in chronic lymphocytic leukemia: an international survey of 1482 patients.

Shanafelt TD, Bowen D, Venkat C, Slager SL, Zent CS, Kay NE, Reinalda M, Sloan JA, Call TG. Mayo Clinic College of Medicine, Rochester, MN, USA.

Although a diagnosis of chronic lymphocytic leukemia (CLL) can have a profound effect on the quality of life (QOL), few studies have objectively measured the QOL of CLL patients or compared it to the general population. We conducted an international, web-based survey of patients with CLL using standardized instruments with published population norms to evaluate fatigue and QOL. Co-morbid health conditions were assessed using the Charlson Co-Morbidity Index. Between June and October 2006, 1482 patients with CLL responded to the survey. The physical, social/family, functional, and overall QOL scores of CLL patients were similar to or better than published population norms. In contrast, the emotional well-being scores of CLL patients were dramatically lower than that of both the general population (P < 0.001) and patients with other types of cancer (P < 0.001). QOL scores were lower among individuals with advanced stage disease (all P < 0.05). Factors associated with lower overall QOL on multivariate analysis included older age, greater fatigue, severity of co-morbid health conditions, and current treatment. CLL has a profound impact on QOL at all disease stages. The effects of CLL on QOL appear to differ from that of other malignancies with a more marked impact on emotional QOL. Research identifying efficacious psycho-oncologic support interventions for patients with CLL is needed.

PMID: 17897301 [PubMed - in process]

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