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Patients with chronic lymphocytic leukemia (CLL) who feel more stress also have more cancer cells in their blood and elevated levels of three other markers of more advanced disease.

A new study of 96 patients is the first to link stress with biological disease markers in patients with CLL.

“All four variables we measured are related to prognosis in CLL patients, so they have a lot of relevance,” said Barbara L. Andersen, lead author of the study and professor of psychology at The Ohio State University.

“It’s more evidence of the importance of managing stress in cancer patients.”

The study appeared Aug. 1 in the journal Cancer.

CLL is the most common leukemia in adults, and accounts for about one-third of adult leukemia in the United States.

The study involved patients who were entering a trial at Ohio State’s Arthur G. James Cancer Hospital for ibrutinib, now approved by the U.S. Food and Drug Administration. At the time of the study, the drug was in early trials to treat the disease. Data collection was done before patients received the first dose.

All patients completed a survey that measured their cancer-related stress. They were asked questions like how often they

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