title: Keep your mind off negative things: coping with long-term effects of acute myeloid leukemia (AML).
abstract: OBJECTIVE
  Acute myeloid leukemia (AML) is characterized by sudden onset, intensive treatment, a poor prognosis, and significant relapse risk. Quality of life (QOL) and well-being among AML survivors have been extensively studied during the 6 months of active treatment. However, it is not clear what survivors experience after active treatment. The purpose of our study was to explore how AML survivors describe their longer-term physical and psychosocial well-being and how they cope with these challenges.
  
  
  METHODS
  We conducted a prospective qualitative study and interviewed 19 adult participants (11 had completed treatment, 8 were receiving maintenance chemotherapy). Data were collected using semi-structured interviews that were audio-recorded and transcribed verbatim. The grounded theory approach was used for data analysis.
  
  
  RESULTS
  A marked improvement in physical health was reported; however, psychosocial well-being was compromised by enduring emotional distress. A range of emotion- and problem-focused coping strategies were reported. Keeping one's mind off negative things through engaging in formal work or informal activities and seeking control were the two most commonly used coping strategies. Seeking social support for reassurance was also common. Problem-focused strategies were frequently described by the ongoing treatment group to manage treatment side effects.
  
  
  CONCLUSIONS
  Although physical symptoms improved after completion of treatment, psychosocial distress persisted over longer period of time. In addition, essential needs of AML survivors shifted across survivorship as psychological burden gradually displaced physical concerns. The integral role of coping mechanisms in the adaptation process suggests a need for effective and ongoing psychological interventions.
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street Suite 130, Toronto, ON, M5T 1P8, Canada. vida.ghodratyjabloo@mail.utoronto.ca.
authors.forename: Vida
authors.initials: V
authors.lastname: Ghodraty-Jabloo
authors.affiliation: Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.|Department of Medicine, University Health Network, Toronto, Canada.|Toronto General Hospital, 14th floor 14 EN214, 200 Elisabeth Street, Toronto, ON, M5G 2C4, Canada.
authors.forename: Shabbir M H
authors.initials: SMH
authors.lastname: Alibhai
authors.affiliation: Department of Medicine, University Health Network, Toronto, Canada.|Toronto General Hospital, 14th floor 14 EN214, 200 Elisabeth Street, Toronto, ON, M5G 2C4, Canada.
authors.forename: Henriette
authors.initials: H
authors.lastname: Breunis
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street Suite 130, Toronto, ON, M5T 1P8, Canada.
authors.forename: Martine T E
authors.initials: MTE
authors.lastname: Puts
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D004644:Emotions; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D011446:Prospective Studies; D011615:Psychotherapy, Group / Q000379:methods*; D036301:Qualitative Research; D011788:Quality of Life; D012944:Social Support; D017741:Survivors / Q000523:psychology*
keywords: Acute myeloid leukemia; Chemotherapy; Coping strategies; Prospective study; Qualitative research; Survivorship