Why do many AML patients report post-traumatic stress symptoms?

Why do many AML patients report post-traumatic stress symptoms? So we know that especially in patients who undergo hematopoietic stem cell transplantation or what we would sometimes call bone marrow transplant or stem cell transplant, there is a sizable medical trauma that happens. When you're in the hospital for weeks at a time, you're having significant symptoms and side effects from treatment. And this too, by the way, happens with high dose chemotherapy and AML, even separate from transplantation, that there is a risk of developing actually post-traumatic stress from that difficult symptom and quality of life experience and that difficult prolonged hospital stay and the trauma of this often sudden diagnosis where you might have been feeling well a few weeks earlier and all of a sudden you're told you have this life-threatening illness and you can't even go home and you've got to be in the hospital and then you're trapped there for a month and you're waiting for bone marrows to come back and maybe nobody can tell you anything at first. It's a very distressing experience and we've heard this time and time again in interview studies and working with so many patients and families. That can lead to the same kind of trauma that happens to people on the battlefield in war. And instead of it coming from maybe things that you've seen and experienced on the battlefield, it can come from those symptom experiences or the traumas of getting sudden unexpected bad news or having to spend time in an ICU, significant physical symptom burden, anxiety, depression kind of symptoms, etc. We know that palliative care integration as part of that difficult experience, whether it be the stem cell transplant experience or high dose chemotherapy experience for AML, can significantly mitigate that risk of post-traumatic stress. So when we have studied this in randomized trials, palliative care integration reduces that risk of having long-term medical trauma, post-traumatic stress at six months and it actually can even reduce caregiver trauma. So many caregivers when they're feeling kind of helpless watching the person that they care about suffer with a diagnosis like AML or go through a transplant can have their own issues with anxiety and depression and other mood symptoms and post-traumatic stress after transplant. And we have even found some evidence that the palliative care integration in these high dose therapies can actually reduce the risk of that in the long term. So this is something we need to study more for sure. We don't know about how this works with low intensity, more outpatient therapies, but the hope and expectation is that by helping with symptoms, quality of life and coping, we probably can also mitigate these issues in low intensity outpatient therapies. So this all goes back to the same message that I continue harping on, which is ask about palliative care and see a specialist if you're dealing with an AML diagnosis because they probably can help to reduce these kinds of issues happening for you and your family or caregiver.