Psychological response of patients with acute leukemia to germ‐free environments

Fifty‐two patients under chemotherapeutic treatment for relapse of acute leukemia were studied for psychological response and adaptation to isolation in “germ‐free” or laminar air‐flow rooms. Psychological assessment was obtained by use of a rating scale based on nurses' observations, a forced‐choice questionnaire, clinical record, and diaries kept by patients in the units. Patients in general adapted to the protected environment and maintained their psychological stability over time. This related in part to receiving intensive and individualized nursing care in a special unit, which contributed to a feeling of security. Mental symptoms described as occurring with sensory deprivation or isolation were not observed. Psychological status was most strongly influenced by physical status. Emotional stability was generally maintained until severe illness developed. Often delirium appeared in the terminal stage of illness, as well as anxiety and depressive symptoms. Patients described the most significant psychological deprivation resulting from the isolated environment as being the loss of the ability to touch or be touched by others. The loss of human physical contact generated feelings of loneliness, from mild to pronounced, in 30% of patients by their own report, but up to 75% as rated by the nurses. Frustration, a sense of coldness, and a lack of emotional warmth with distance from others were described. A technique is presented of systematic observation and assessment of behavior by medical nurses, which allowed a quantitative and continuous psychological evaluation of patients in a stressful hospital environment. Cancer 40:871–879, 1977.