{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:25:25Z","timestamp":1791390325358,"version":"4.3.3"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T00:00:00Z","timestamp":1698969600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Hematological cancer patients must comply with extensive medical instructions to prevent cancer progression or relapse. Psychological comorbidities and patient characteristics have been shown to affect compliance. However, the impact of posttraumatic stress disorder (PTSD) and adjustment disorder (AjD) on compliance in cancer patients remains unclear. This study aims to evaluate compliance in hematological cancer patients more comprehensively and to investigate its association with PTSD and AjD symptomatology as well as sociodemographic and medical factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Hematological cancer patients were cross-sectionally assessed via validated questionnaires for PTSD (PCL-5) and AjD (ADMN-20), and three internally developed items on compliance with medical regimen, with two referring to compliance behavior and one item assessing perceived difficulties with complying. Each compliance item was analyzed descriptively. Multiple linear regression models tested the association between compliance and PTSD and AjD symptomatology, sociodemographic and medical factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 291 patients were included (response rate 58%). Nine out of ten patients reported to either never (67%) or rarely (25%) change their medical regimen. However, 8% reported to change it once in a while or often. Compliance behavior was mostly rated as very easy (36%) or easy (45%) to implement. Nevertheless, 19% perceived it to be partly difficult or difficult to follow medical regimen. Symptoms of AjD (\u03b2 = 0.31, <jats:italic>p<\/jats:italic> &amp;lt; 0.001) were associated with more difficulties to comply. Higher compliance behavior in turn was associated with stem cell transplantation (SCT) treatment (\u03b2 = \u22120.21, <jats:italic>p<\/jats:italic> &amp;lt; 0.001) and lower education (\u03b2 = \u22120.19, <jats:italic>p<\/jats:italic> = 0.002).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Although most patients indicated that they comply with medical regimen, a considerable subgroup of patients indicated subjectively perceived difficulties and thus seem to require additional support in implementing medical instructions possibly through improved medical communication and patient health literacy or shared decision-making.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyg.2023.1278485","type":"journal-article","created":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T09:02:24Z","timestamp":1699002144000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Compliance with medical regimen among hematological cancer patients and its association with symptoms of posttraumatic stress disorder and adjustment disorder"],"prefix":"10.3389","volume":"14","author":[{"given":"Franziska","family":"Springer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Esser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Friedrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen","family":"Ernst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Platzbecker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladan","family":"Vucinic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Mehnert-Theuerkauf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,11,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1002\/pon.3654","article-title":"A meta-analysis of prevalence rates and moderating factors for cancer-related post-traumatic stress disorder.","volume":"24","author":"Abbey","year":"2015","journal-title":"Psychooncology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1941","DOI":"10.1245\/s10434-012-2793-5","article-title":"Association of depression and anxiety on quality of life, treatment adherence, and prognosis in patients with advanced non-small cell lung cancer.","volume":"20","author":"Arrieta","year":"2013","journal-title":"Ann. Surg. Oncol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1002\/jts.22059","article-title":"The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation.","volume":"28","author":"Blevins","year":"2015","journal-title":"J. Traumatic Stress"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-017-3735-1","article-title":"Prevalence and associated factors of medication non-adherence in hematological-oncological patients in their home situation.","volume":"17","author":"Bouwman","year":"2017","journal-title":"BMC Cancer"},{"key":"B5","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1037\/0033-2909.112.1.155","article-title":"A power primer.","volume":"112","author":"Cohen","year":"1992","journal-title":"Psychol Bull"},{"key":"B6","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1016\/S2215-0366(17)30014-7","article-title":"Post-traumatic stress disorder and cancer.","volume":"4","author":"Cordova","year":"2017","journal-title":"Lancet Psychiatry"},{"key":"B7","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1080\/09540120410001641084","article-title":"Posttraumatic stress disorder symptoms, salivary cortisol, medication adherence, and CD4 levels in HIV-positive individuals.","volume":"16","author":"Delahanty","year":"2004","journal-title":"AIDS Care"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.14.2101","article-title":"Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence.","volume":"160","author":"DiMatteo","year":"2000","journal-title":"Arch. Intern. Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1016\/j.psychres.2015.07.010","article-title":"Adjustment disorder as proposed for ICD-11: Dimensionality and symptom differentiation.","volume":"229","author":"Glaesmer","year":"2015","journal-title":"Psychiatry Res"},{"key":"B10","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/j.critrevonc.2015.08.025","article-title":"To adhere or not to adhere: Rates and reasons of medication adherence in hematological cancer patients.","volume":"97","author":"Hall","year":"2016","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1038\/s41409-018-0371-6","article-title":"Psychosocial Assessment of Candidates for Transplantation scale (PACT) and survival after allogeneic hematopoietic stem cell transplantation.","volume":"54","author":"Harashima","year":"2019","journal-title":"Bone Marrow Transpl"},{"key":"B12","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1007\/s10549-018-5050-1","article-title":"Impact of preexisting mental illness on breast cancer endocrine therapy adherence.","volume":"174","author":"Haskins","year":"2019","journal-title":"Breast Cancer Res. Treat"},{"key":"B13","doi-asserted-by":"publisher","first-page":"237.e7","DOI":"10.1016\/j.urolonc.2020.11.033","article-title":"Post-traumatic stress disorder symptoms in non-muscle-invasive bladder cancer survivors: A population-based study.","volume":"39","author":"Jung","year":"2021","journal-title":"Urologic Oncol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"2192","DOI":"10.1161\/STROKEAHA.112.655209","article-title":"Posttraumatic stress disorder and adherence to medications in survivors of strokes and transient ischemic attacks.","volume":"43","author":"Kronish","year":"2012","journal-title":"Stroke"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-017-1541-6","article-title":"The German version of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Psychometric properties and diagnostic utility.","volume":"17","author":"Kr\u00fcger-Gottschalk","year":"2017","journal-title":"BMC Psychiatry"},{"key":"B16","doi-asserted-by":"publisher","first-page":"215","DOI":"10.15171\/ijoem.2016.775","article-title":"The adjustment disorder\u2013new module 20 as a screening instrument: Cluster analysis and cut-off values.","volume":"7","author":"Lorenz","year":"2016","journal-title":"Int. J. Occup. Environ. Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1002\/pon.1057","article-title":"Prevalence of acute and post-traumatic stress disorder and comorbid mental disorders in breast cancer patients during primary cancer care: A prospective study.","volume":"16","author":"Mehnert","year":"2007","journal-title":"Psychooncology"},{"key":"B18","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/S1470-2045(11)70002-X","article-title":"Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: A meta-analysis of 94 interview-based studies.","volume":"12","author":"Mitchell","year":"2011","journal-title":"Lancet Oncol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1016\/j.bbmt.2017.01.008","article-title":"Medication adherence in hematopoietic stem cell transplantation: A review of the literature.","volume":"23","author":"Morrison","year":"2017","journal-title":"Biol. Blood Marrow Transplant."},{"key":"B20","doi-asserted-by":"publisher","first-page":"5401","DOI":"10.1182\/blood-2008-12-196543","article-title":"Prevalence, determinants, and outcomes of nonadherence to imatinib therapy in patients with chronic myeloid leukemia: The ADAGIO study.","volume":"113","author":"Noens","year":"2009","journal-title":"Blood"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.1017\/S0033291709992285","article-title":"Depression and cancer mortality: A meta-analysis.","volume":"40","author":"Pinquart","year":"2010","journal-title":"Psychol. Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"6063","DOI":"10.1200\/JCO.2005.05.751","article-title":"Role of depression as a predictor of mortality among cancer patients after stem-cell transplantation.","volume":"23","author":"Prieto","year":"2005","journal-title":"J. Clin. Oncol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1093\/annonc\/mdt433","article-title":"Factors influencing adherence to cancer treatment in older adults with cancer: A systematic review.","volume":"25","author":"Puts","year":"2014","journal-title":"Ann. Oncol"},{"key":"B24","year":"2021","journal-title":"R: A language and environment for statistical computing."},{"key":"B25","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1037\/0003-066X.41.7.813","article-title":"Approach, avoidance, and coping with stress.","volume":"41","author":"Roth","year":"1986","journal-title":"Am. Psychol"},{"key":"B26","article-title":"Angeh\u00f6rigenpartizipation und compliance in der h\u00e4matologischen onkologie","author":"Schr\u00f6,der","year":"2008","journal-title":"Psychosoziale Aspekte K\u00f6rperlicher Krankheiten. Abstracts Zum Gemeinsamen Kongress Der Deutschen Gesellschaft F\u00fcr Medizinische Psychologie Und Der Deutschen Gesellschaft F\u00fcr Medizinische Soziologie"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38875.675486.55","article-title":"A meta-analysis of the association between adherence to drug therapy and mortality.","volume":"333","author":"Simpson","year":"2006","journal-title":"BMJ"},{"key":"B28","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1200\/JCO.2007.12.3414","article-title":"Post-traumatic stress outcomes in Non-Hodgkin\u2019s Lymphoma survivors.","volume":"26","author":"Smith","year":"2008","journal-title":"J. Clin. Oncol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1080\/0284186X.2023.2239477","article-title":"Symptoms of posttraumatic stress disorder and adjustment disorder in hematological cancer patients with different treatment regimes.","volume":"62","author":"Springer","year":"2023","journal-title":"Acta Oncol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1182\/asheducation-2001.1.392","article-title":"Preventing opportunistic infections after hematopoietic stem cell transplantation: The Centers for Disease Control and Prevention, infectious diseases society of America, and American society for blood and marrow transplantation practice guidelines and beyond.","volume":"2001","author":"Sullivan","year":"2001","journal-title":"Hematology"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.4081\/oncol.2012.e5","article-title":"A literature review to investigate the link between psychosocial characteristics and treatment adherence in cancer patients.","volume":"6","author":"Theofilou","year":"2012","journal-title":"Oncol. Rev"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.1007\/s00520-021-06530-0","article-title":"Adjustment disorder in cancer patients after treatment: Prevalence and acceptance of psychological treatment.","volume":"30","author":"Van Beek","year":"2022","journal-title":"Support Care Cancer"},{"key":"B33","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1080\/10810730.2013.825668","article-title":"The relationship between health, education, and health literacy: Results from the Dutch adult literacy and life skills survey.","volume":"18","author":"Van Der Heide","year":"2013","journal-title":"J. Health Commun."},{"key":"B34","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1016\/j.ctrv.2012.12.014","article-title":"Determinants and associated factors influencing medication adherence and persistence to oral anticancer drugs: A systematic review.","volume":"39","author":"Verbrugghe","year":"2013","journal-title":"Cancer Treat. Rev"},{"key":"B35","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.6004\/jnccn.2008.2003","article-title":"NCCN task force report: Oral chemotherapy.","volume":"6","author":"Weingart","year":"2008","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V114.22.4270.4270","article-title":"Non-adherence to Imatinib in chronic myeloid leukemia patients is associated with a short term and long term negative impact on healthcare utilization and costs.","volume":"114","author":"Wu","year":"2009","journal-title":"Blood"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1964","DOI":"10.1093\/annonc\/mdx265","article-title":"First-onset mental disorders after cancer diagnosis and cancer-specific mortality: A nationwide cohort study.","volume":"28","author":"Zhu","year":"2017","journal-title":"Ann. Oncol"}],"container-title":["Frontiers in Psychology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2023.1278485\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T09:02:30Z","timestamp":1699002150000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyg.2023.1278485\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,3]]},"references-count":37,"alternative-id":["10.3389\/fpsyg.2023.1278485"],"URL":"https:\/\/doi.org\/10.3389\/fpsyg.2023.1278485","relation":{},"ISSN":["1664-1078"],"issn-type":[{"value":"1664-1078","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,3]]},"article-number":"1278485"}}