1
|
Williams AM, Rodday AM, Pei Q, Henderson TO, Keller FG, Punnett A, Kelly KM, Castellino SM, Parsons SK. Longitudinal Health-Related Quality of Life Among Patients With High-Risk Pediatric Hodgkin Lymphoma Treated on the Children's Oncology Group AHOD 1331 Study. J Clin Oncol 2024; 42:3330-3338. [PMID: 39058966 PMCID: PMC11481752 DOI: 10.1200/jco.24.00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/18/2024] [Accepted: 04/30/2024] [Indexed: 07/28/2024] Open
Abstract
PURPOSEThere have been no previous longitudinal assessments of health-related quality of life (HRQoL) during treatment for pediatric Hodgkin lymphoma (HL). The addition of brentuximab vedotin (BV) to a multidrug chemotherapy backbone demonstrated superior efficacy to standard chemotherapy for patients with pediatric high-risk HL in the AHOD 1331 trial. However, the impact on HRQoL is unknown.PATIENTS AND METHODSAfter treatment random assignment, 268 participants older than 11 years were enrolled in a prespecified, longitudinal, patient-reported outcomes substudy. HRQoL was assessed using the seven-item Child Health Ratings Inventories (CHRIs)-Global scale before treatment (T1) and at cycle 2 (T2), cycle 5 (T3), and end of treatment (T4). A clinically meaningful increase in HRQoL was considered 7 points on the CHRIs-Global. Multivariable linear regression estimated associations between demographic/clinical variables and HRQoL at T1. Linear mixed models estimated changes in HRQoL across the treatment arm.RESULTSParticipant characteristics were balanced by treatment arm. Ninety-three percent of participants completed the CHRIs at T1, 92% at T2, 89% at T3, and 77% at T4. At T1, female sex and fever (P < .05) were each associated with worse HRQoL. By T2, participants in the BV arm experienced a statistically and clinically significant improvement in HRQoL (β = 7.3 [95% CI, 3.2 to 11.4]; P ≤ .001), which was greater than the change in the standard arm (difference in change β = 5.1 [95% CI, -0.2 to 10.3]; P = .057). The standard arm did not experience a statistically or clinically significant increase in HRQoL until T4 (β = 9.3 [95% CI, 4.7 to 11.5]; P < .001).CONCLUSIONThese data demonstrate successful collection of serial HRQoL from youth with high-risk pediatric HL and improvement in HRQoL over the course of initial therapy, sooner and to a greater extent in the group receiving the novel agent BV.
Collapse
Affiliation(s)
- AnnaLynn M Williams
- Department of Surgery, Division of Supportive Care in Cancer, University of Rochester Medical Center, Rochester, NY
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Qinglin Pei
- Department of Biostatistics, University of Florida, Gainesville, FL
| | - Tara O Henderson
- Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago, IL
| | - Frank G Keller
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Angela Punnett
- Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | | | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| |
Collapse
|
2
|
Oerlemans S, Efficace F, Shamieh O, Cardoso Borges F, de Jong C, Dong D, Lehmann J, Malak S, Petranovic D, Scholz CW, Caocci G, Molica S, Griskevicius L, Nagele E, Bredart A, Carvalho E, Xochelli A, Agelink van Rentergem J, Alrjoob W, Mueller A, Freitas AC, Cocks K, Creutzberg C, Kyriakou C, van de Poll-Franse L. International validation of a health-related quality-of-life questionnaire for Hodgkin lymphoma: the EORTC QLQ-HL27. Blood Adv 2023; 7:7045-7055. [PMID: 37738090 PMCID: PMC10694520 DOI: 10.1182/bloodadvances.2023010841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/13/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023] Open
Abstract
Hodgkin lymphoma (HL) has become 1 of the most curable cancers. Therefore, rigorous assessment of health-related quality of life (HRQoL) and symptom burden of these patients is essential to support informed clinical decisions. The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group previously developed the EORTC Quality of Life Questionnaire (QLQ) Hodgkin Lymphoma 27. This paper reports the final results of an international study by the EORTC group to develop a HRQoL disease-specific measure for these patients: the EORTC QLQ-HL27. Patients with a confirmed diagnosis of HL (N = 381) were enrolled from 12 countries and completed the EORTC QLQ-C30, QLQ-HL27, and a debriefing questionnaire at baseline (any time after diagnosis). A subset completed a retest (n = 126) or responsiveness-to-change analyses (RCA) second measurement (n = 98). Psychometrics were evaluated. Confirmatory factor analysis showed an acceptable fit of the 27 items of the QLQ-HL27 on its 4 scales (symptom burden, physical condition/fatigue, emotional impact, and worries about health/functioning). Test-retest reliability, convergent validity, known-group comparisons, and RCA find satisfactory results. Symptom burden and fatigue was higher among patients on treatment (with 36%-83% reporting at least a few problems) compared with those who had completed treatment (19%-61% reporting at least a few problems). Prevalence of worries about health and functioning (reporting at least some worry) was similar for patients on treatment (51%-81%) vs those who had completed treatment (52%-78%). Implementation of the EORTC QLQ-HL27 in research and clinical applications will increase sensitivity of HRQoL assessment in patients with HL. High quality data generated through use of this questionnaire are expected to facilitate clinical decision making in the HL setting.
Collapse
Affiliation(s)
- Simone Oerlemans
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Fabio Efficace
- Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases Data Centre, Rome, Italy
| | - Omar Shamieh
- Department of Palliative Medicine, King Hussein Cancer Center, Amman, Jordan
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Fabio Cardoso Borges
- Department of Epidemiology and National Cancer Registry, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Corine de Jong
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dong Dong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jens Lehmann
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Sandra Malak
- Hôpital René Huguenin-Institut Curie- Hématologie, Saint-Cloud, France
| | - Duska Petranovic
- Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia
| | | | - Giovanni Caocci
- Hematology, Businco Hospital, University of Cagliari, Cagliari, Italy
| | | | - Laimonas Griskevicius
- Hematology, Oncology and Transfusion Medicine, Vilnius University Hospital Santaros Klinikos and Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Eva Nagele
- Medical University of Graz, Graz, Austria
| | - Anne Bredart
- Institut Curie Psycho-Oncology Unit; Paris University, Psychopathology and Health Process Laboratory (UR 4057); PSL University, Paris, France
| | - Elisabete Carvalho
- Department of Epidemiology and National Cancer Registry, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
- Clinical Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Aliki Xochelli
- Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece
| | - Joost Agelink van Rentergem
- Department of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Waleed Alrjoob
- Department of Palliative Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Anja Mueller
- Hematology and Oncology, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Ana Carolina Freitas
- Hematology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Kim Cocks
- York Trials Unit, University of York, York & Adelphi Values, Cheshire, United Kingdom
| | - Carien Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Lonneke van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
3
|
Mian H, Ringash J, Meyer R, Hay AE, Shepherd L, Djurfeldt M, Winter JN, Sussman J, Pater J, Chen BE, Prica A. Health-related quality of life in early-stage Hodgkin lymphoma: a longitudinal analysis of the ABVD arm in the randomized controlled trial HD.6. Support Care Cancer 2023; 31:256. [PMID: 37043087 DOI: 10.1007/s00520-023-07717-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 03/29/2023] [Indexed: 04/13/2023]
Abstract
Early-stage Hodgkin lymphoma has become one of the most curable hematologic malignancies. Depending upon the disease location, possible toxicities, and patient preference, chemotherapy alone with ABVD remains an accepted treatment modality for this disease. There remains a paucity of data regarding the longitudinal trajectory of health-related quality of life (HRQoL) in patients treated for HL. The impact of disease and treatment on HRQoL is increasingly important to understand as the number of long-term survivors increases. We report the longitudinal HRQoL using data prospectively collected from diagnosis up to 10 years post-treatment in the ABVD arm of the HD.6 randomized controlled trial for early-stage HL patients (N=169). We analyzed HRQoL using the EORTC QLQ-C30 collected at baseline, 3 months, 6 months, and 12 months after completion of chemotherapy and yearly up to year 10. Clinically and statistically significant improvements were noted for specific domains including emotional (3 months post-treatment), social (12 months post-treatment) and financial functioning (2 years post-treatment), and the specific symptom of fatigue (6 months post-treatment) during the follow-up period. To our knowledge, this is the first prospective, longitudinal analysis of HRQoL specifically among patients with early-stage HL treated with ABVD therapy alone. Although improvements were noted, sustained clinically and statistically significant improvements were noted only in select symptoms emphasizing the need to better understand and optimize HRQoL among this patient group.
Collapse
Affiliation(s)
- Hira Mian
- Department of Oncology, McMaster University, 699 Concession St, Hamilton, ON, L8V 5C2, Canada.
| | - Jolie Ringash
- Cancer Clinical Research Unit (CCRU), Princess Margaret Cancer Centre/UHN, University of Toronto, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Ralph Meyer
- Department of Oncology, McMaster University, 699 Concession St, Hamilton, ON, L8V 5C2, Canada
| | - Annette E Hay
- Canadian Cancer Trials Group, Department of Medicine, Queen's University, Kingston, Canada
| | - Lois Shepherd
- Canadian Cancer Trials Group, Department of Pathology & Molecular Medicine, Queen's University, Kingston, Canada
| | - Marina Djurfeldt
- Canadian Cancer Trials Group, Queen's University, Kingston, Canada
| | - Jane N Winter
- Northwestern University, Feinberg School of Medicine, Illinois, USA
| | - Jonathan Sussman
- Department of Oncology, McMaster University, 699 Concession St, Hamilton, ON, L8V 5C2, Canada
| | - Joseph Pater
- Canadian Cancer Trials Group, Queen's University, Kingston, Canada
| | - Bingshu E Chen
- Canadian Cancer Trials Group, Department of Public Health Sciences and Department of Mathematics and Statistics, Queen's University, Kingston, Canada
| | - Anca Prica
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| |
Collapse
|
4
|
McGovern KA, Durham WJ, Wright TJ, Dillon EL, Randolph KM, Danesi CP, Urban RJ, Sheffield-Moore M. Impact of Adjunct Testosterone on Cancer-Related Fatigue: An Ancillary Analysis from a Controlled Randomized Trial. Curr Oncol 2022; 29:8340-8356. [PMID: 36354718 PMCID: PMC9689748 DOI: 10.3390/curroncol29110658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Many cancer patients undergoing treatment experience cancer-related fatigue (CRF). Inflammatory markers are correlated with CRF but are not routinely targeted for treatment. We previously demonstrated in an NIH-funded placebo-controlled, double-blind, randomized clinical trial (NCT00878995, closed to follow-up) that seven weekly injections of 100 mg adjunct testosterone preserved lean body mass in cancer patients undergoing standard-of-care treatment in a hospital setting. Because testosterone therapy can reduce circulating proinflammatory cytokines, we conducted an ancillary analysis to determine if this testosterone treatment reduced inflammatory burden and improved CRF symptoms and health-related quality of life. Randomization was computer-generated and managed by the pharmacy, which dispensed testosterone and placebo in opaque syringes to the administering study personnel. A total of 24 patients were randomized (14 placebo, 10 testosterone), and 21 were included in the primary analysis (11 placebo, 10 testosterone). Testosterone therapy did not ameliorate CRF symptoms (placebo to testosterone difference in predicted mean multidimensional fatigue symptom inventory scores: -5.6, 95% CI: -24.6 to 13.3), improve inflammatory markers, or preserve health-related quality of life and functional measures of performance in late-stage cancer patients.
Collapse
Affiliation(s)
- Kristen A. McGovern
- Department of Internal Medicine, The University of Texas Medical Branch (UTMB), 301 University Blvd., Galveston, TX 77555, USA
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Abstract
PURPOSE OF REVIEW With an increasing number of long-term lymphoma survivors, there has been emphasis on optimizing quality of life and identifying survivorship challenges. This review summarizes the latest advancements pertaining to health-related quality of life and survivorship in lymphoma. RECENT FINDINGS Quality of life can vary from diagnosis through survivorship though some physical, social, and emotional effects may be persistent. Incorporation of patient reported outcomes enables recognition of factors that significantly impact quality of life. A greater understanding of quality of life and survivorship issues has generated momentum for practice change, improving education, and designing behavior related interventions. Patients with lymphoma face many challenges as they navigate their cancer experience. There is a tremendous opportunity to build upon this work through well-designed prospective longitudinal studies aimed at identifying vulnerable patient groups and impactful points of intervention during survivorship.
Collapse
|
6
|
Kumar AJ, Murphy-Banks R, Weidner RA, Parsons SK. Perceptions of Role in Treatment Decision Making and Understanding of Late Effects Among Hodgkin Lymphoma Survivors: Results From a National Survey HL Decision Making and Late Effects. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 22:e65-e69. [PMID: 34452864 DOI: 10.1016/j.clml.2021.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hodgkin Lymphoma (HL) survivors are at risk of treatment-related late effects (LEs). With these potential risks and increasing numbers of treatment options for newly diagnosed patients, communication and shared decision making are essential to supporting patients throughout the cancer care continuum. We aimed to gather perspectives of HL survivors about their actual role in treatment decision making and their understanding of LEs. MATERIALS AND METHODS After initial pilot testing at a cancer survivor conference, we disseminated a 23-question survey in a single-wave e-mail through the Leukemia & Lymphoma Society's national listserv. We focused on 4 constructs: (1) patient's understanding of HL at diagnosis; (2) initial discussions with an oncologist; (3) factors in decision making of treatment, and (4) current health status. RESULTS A total of 135 participants responded to the survey. While 73% of survey respondents perceived some involvement in decision making, one-half of respondents felt the treatment plan was a shared decision with their provider. Among patient-level factors, side effects/LEs were most frequently endorsed as important to treatment decisions. Eighty-four percent of respondents had been educated about risk for potential LEs. Thirty-six percent had been diagnosed with a LE at the time of survey completion with 3% reporting a second cancer diagnosis. CONCLUSION Survey respondents described their role in treatment decision making for newly diagnosed HL. Nearly half of patients did not endorse participating in shared decision making. A substantial number had experienced LEs. Future work should focus on improving patient-provider communication in decision processes for newly diagnosed HL.
Collapse
Affiliation(s)
- Anita J Kumar
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA; Division of Hematology/Oncology, Tufts Medical Center, Boston, MA.
| | - Rachel Murphy-Banks
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Ruth Ann Weidner
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Susan K Parsons
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA; Division of Hematology/Oncology, Tufts Medical Center, Boston, MA; Department of Medicine and Pediatrics, Tufts University School of Medicine, Boston, MA
| |
Collapse
|
7
|
Wayant C, Manquen J, Wendelbo H, Kerr N, Crow M, Goodell J, Tricco AC, Mack JW, Hellman C, Vassar M. Identification of Evidence for Key Positive Psychological Constructs in Pediatric and Adolescent/Young Adult Patients with Cancer: A Scoping Review. J Adolesc Young Adult Oncol 2021; 10:247-259. [PMID: 33464990 PMCID: PMC8220547 DOI: 10.1089/jayao.2020.0184] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Children and adolescents/young adults (AYAs) with cancer are a vulnerable population susceptible to numerous late effects, such as fatigue and depression, which may diminish their long-term psychological, physical, spiritual, and emotional health. A well-rounded understanding of how positive psychological constructs affect the quality of care and treatment outcomes is therefore warranted. Methods: We conducted a scoping review of 15 positive psychological constructs in children and AYAs with cancer. The primary research questions were (1) what is known about positive psychological constructs in children and AYAs with cancer; (2) what value is ascribed to these constructs by patients? Results: Two hundred seventy-six articles were included after database search and screening. These studies were mostly observational or qualitative and conducted in North America. Constructs were often poorly defined, and measurement tools used to gather data were wide ranging. Numerous factors were correlated with increased or decreased expression of certain constructs, but overall themes were difficult to identify. Similarly, patients often spoke of what increased or decreased expression of a construct, with less emphasis on what they implicitly value. Discussion: This scoping review found ample evidence for what increases or decreases expression of positive psychological constructs, but this evidence was observational and often conflicting. In the future, we recommend the development of a core set of psychological outcomes, with definitions and corresponding measurement tools. We further recommend an emphasis on randomized trials to more rigorously study how expression of constructs can be improved and what effect this has on the quality of life.
Collapse
Affiliation(s)
- Cole Wayant
- Department of Psychiatry and Behavioral Sciences and Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Jack Manquen
- Department of Psychiatry and Behavioral Sciences and Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Hannah Wendelbo
- Department of Psychiatry and Behavioral Sciences and Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Natalie Kerr
- Department of Psychiatry and Behavioral Sciences and Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Matt Crow
- Department of Psychiatry and Behavioral Sciences and Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Jon Goodell
- Department of Library Services, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Andrea C. Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jennifer W. Mack
- Division of Population Sciences, Department of Pediatric Oncology, Dana Farber Cancer Institute/Boston Children's Hospital, Boston, Massachusetts, USA
| | - Chan Hellman
- School of Social Work, University of Oklahoma, Norman, Oklahoma, USA
| | - Matt Vassar
- Department of Psychiatry and Behavioral Sciences and Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| |
Collapse
|
8
|
Tarnasky AM, Troy JD, LeBlanc TW. The patient experience of ABVD treatment in Hodgkin lymphoma: a retrospective cohort study of patient-reported distress. Support Care Cancer 2021; 29:4987-4996. [PMID: 33576877 DOI: 10.1007/s00520-021-06044-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/04/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Psychological distress is prevalent in Hodgkin lymphoma (HL). Many patients, regardless of prognosis, receive ABVD chemotherapy as first-line treatment, but few studies have specifically examined the nature of distress during this shared treatment experience. METHODS We conducted a retrospective study of patient-reported distress in HL patients receiving ABVD treatment at a single tertiary care facility. Distress was measured using the National Comprehensive Cancer Network Distress Thermometer and Problem List (PL). We used descriptive statistics and generalized estimating equations to assess the prevalence of distress and specific problem items during treatment and associations with patient- and disease-related factors. RESULTS We collected data from 50 patients comprising 467 unique encounters, with 369/467 (79.0%) reporting a distress thermometer score. Median distress score was 2 (IQR: 0-5), but actionable distress (distress thermometer ≥4) was noted for 118/369 (32.0%) encounters. Actionable distress was only related to having a prior cancer, which conferred lower odds of actionable distress (OR 0.23, 95% CI 0.07-0.74, p=0.01) Physical and emotional problems were reported for 287/369 (77.8%) and 125/369 (33.9%) visits, respectively. Female patients had greater odds of both physical (OR 3.17, 95% CI 1.32-7.66, p=0.01) and emotional (OR 3.31, 95% CI 1.25-8.73, p=0.02) problems. CONCLUSION ABVD treatment is associated with a high frequency of actionable distress, with physical and emotional problems acting as primary drivers. Female patients may be particularly vulnerable, while cancer survivors may be uniquely resilient. These findings demonstrate the need to thoroughly screen for and appropriately tailor distress management strategies for HL patients during treatment with ABVD.
Collapse
Affiliation(s)
| | - Jesse D Troy
- Division of Biostatistics, Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC, 27710, USA. .,Duke Cancer Institute, Box 2715, DUMC,, Durham, NC, 27710, USA.
| |
Collapse
|
9
|
Parsons SK. Longitudinal Assessment of Health-Related Quality of Life Among Survivors of Hodgkin Lymphoma: It Is About Time! J Clin Oncol 2020; 38:2821-2823. [PMID: 32650684 DOI: 10.1200/jco.20.01585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
10
|
Kreissl S, Müller H, Goergen H, Meissner J, Topp M, Sökler M, Markova J, Bernhard J, Greil R, von Tresckow B, Behringer K, Rüffer JU, Flechtner HH, Möstl M, Fuchs M, Engert A, Diehl V, Borchmann P. Health-Related Quality of Life in Patients With Hodgkin Lymphoma: A Longitudinal Analysis of the German Hodgkin Study Group. J Clin Oncol 2020; 38:2839-2848. [PMID: 32574114 DOI: 10.1200/jco.19.03160] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Many important details of health-related quality of life (HRQoL) after diagnosis and treatment of Hodgkin lymphoma (HL) are still unknown because large longitudinal studies of HRQoL are rare. Therefore, we analyzed a systematically assessed, comprehensive range of HRQoL domains in patients with HL of all stages from diagnosis up to 5 years of survivorship. PATIENTS AND METHODS We included patients with HL age 18-60 years at diagnosis from the German Hodgkin Study Group trials HD13, HD14, and HD15. We analyzed HRQoL using all functional and symptom scales of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 including deviations from reference values. We estimated the effect of different disease, patient, and treatment characteristics using multiple regression and repeated measures analysis and computed correlations of HRQoL scores. RESULTS We analyzed 4,215 patients with any HRQoL assessment within 5 years after treatment. Higher tumor burden at diagnosis was associated with impaired baseline scores in many HRQoL domains. During survivorship, cognitive, emotional, role, and social functioning and fatigue, dyspnea, sleep, and financial problems were severely and persistently affected. From year 2 on, mean deviations from reference values ranged between 12 and 29 points, with 10 points being a commonly used margin of clinical relevance. In all 3 trials, HRQoL domains 2 and 5 years after therapy were significantly influenced by baseline scores and age but not by randomized treatments. Fatigue was most closely correlated with other symptoms and scales. CONCLUSION Our results show a high and persistent amount of different HRQoL deficits in survivors of HL that are largely independent of the applied chemotherapies. Our analysis underscores the high, unmet medical need of these rather young survivors of HL regarding the psychosocial adverse effects of the cancer experience.
Collapse
Affiliation(s)
- Stefanie Kreissl
- German Hodgkin Study Group, University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Horst Müller
- German Hodgkin Study Group, University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Helen Goergen
- German Hodgkin Study Group, University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | | | - Max Topp
- University Hospital of Würzburg, Würzburg
| | - Martin Sökler
- Hematology Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Jana Markova
- Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jürg Bernhard
- Department of Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Swiss Group for Clinical Cancer Research, Berne, Switzerland
| | - Richard Greil
- Third Medical Department, Paracelsus Medical University, Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria
| | - Bastian von Tresckow
- German Hodgkin Study Group, University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Karolin Behringer
- German Hodgkin Study Group, University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | | | - Hans-Henning Flechtner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Michaela Möstl
- Third Medical Department, Hanusch Krankenhaus, Vienna, Austria
| | - Michael Fuchs
- German Hodgkin Study Group, University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Andreas Engert
- German Hodgkin Study Group, University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Volker Diehl
- German Hodgkin Study Group, University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Peter Borchmann
- German Hodgkin Study Group, University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| |
Collapse
|
11
|
Trachtenberg E, Gurion R, Mashiach T, Tadmor T, Kedmi M, Dann EJ. Recognizing severe fatigue and decline in quality of life in Hodgkin lymphoma survivors. Leuk Lymphoma 2019; 60:3449-3454. [PMID: 31331223 DOI: 10.1080/10428194.2019.1641803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hodgkin lymphoma (HL) is common in young adults and considered curable in most patients. Young HL survivors (HLS) are at risk of long-term adverse effects. Our study aimed to assess various fatigue and quality of life (QoL) complaints, and their correlations with treatment. Self-reported questionnaires assessing fatigue (MFI-20) and QoL-related issues (EORTC-QOL-C-30) were used to examine HLS aged 18-65 who completed first-line chemotherapy ± radiotherapy (RT) and were in complete remission for at least six months post-therapy. The cohort included 120 HLS (median age 32 years), assessed between 6 months and 15 years post-treatment. About 28% presented with severe fatigue and severely reduced QoL. Higher fatigue levels were associated with four cycles of the ABVD + RT. Young HLS experience high levels of persistent physical fatigue, emotional distress, and cognitive decline that are insufficiently investigated. Assessment of these complaints is essential and further investigation may provide tailored solutions for a better QoL for HLS.
Collapse
Affiliation(s)
- Estherina Trachtenberg
- The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Psychology Department, Anglia Ruskin University, Cambridge, UK
| | - Ronit Gurion
- Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tatiana Mashiach
- Quality Assurance Unit, Rambam Health Care Campus, Haifa, Israel
| | - Tamar Tadmor
- The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Bnai Zion Medical Center, Hematology Unit, Haifa, Israel
| | - Meirav Kedmi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Eldad J Dann
- The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| |
Collapse
|
12
|
Patient-reported distress in Hodgkin lymphoma across the survivorship continuum. Support Care Cancer 2018; 27:2453-2462. [PMID: 30377801 PMCID: PMC6541572 DOI: 10.1007/s00520-018-4523-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/19/2018] [Indexed: 12/25/2022]
Abstract
Purpose Hodgkin lymphoma (HL) survivors face long-term, elevated risk of treatment-related sequelae, including psychosocial distress associated with poor health outcomes. The magnitude and sources of distress are not well described in the routine care of HL outside of clinical trials. Methods We conducted a retrospective cohort study of patients visiting a tertiary-care center for treatment or long-term follow-up of HL. Patient-reported distress was documented using the National Comprehensive Cancer Network Distress Thermometer (DT) and Problem List. Three survivor groups were compared using descriptive methods: on treatment, surviving < 5 years, and surviving ≥ 5 years since diagnosis. Results A total of 1524 DT were abstracted for 304 patients (106 on treatment, 77 surviving < 5 years, and 121 surviving ≥ 5 years). Distress was low overall (median DT = 1, inter-quartile range 0–4) and was similar across survivor groups. However, actionable distress (score ≥ 4) was reported at 29.5% of clinical encounters. Patients on treatment more frequently reported actionable distress (32.5% of visits) compared with patients surviving < 5 years (20.4%) and ≥ 5 years (28.7%) (P = 0.065). Distress was associated primarily with physical and emotional problems, especially fatigue, worry, and sleep. We did not observe any associations between distress and clinical prognostic factors. Conclusions Distress burden is low in HL, but survivorship is marked by periods of actionable distress, largely related to physical symptoms and emotional issues. This burden may be higher when on treatment and is unrelated to disease-related prognostic factors. Survivorship research typically focuses on the post-therapy period, but our results support testing the efficacy of interventions to address distress in HL during active treatment as well.
Collapse
|
13
|
Arts LPJ, van de Poll-Franse LV, van den Berg SW, Prins JB, Husson O, Mols F, Brands-Nijenhuis AVM, Tick L, Oerlemans S. Lymphoma InterVEntion (LIVE) - patient-reported outcome feedback and a web-based self-management intervention for patients with lymphoma: study protocol for a randomised controlled trial. Trials 2017; 18:199. [PMID: 28454583 PMCID: PMC5408371 DOI: 10.1186/s13063-017-1943-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/11/2017] [Indexed: 12/27/2022] Open
Abstract
Background Patients with lymphoma are at risk of experiencing adverse physical and psychosocial problems from their cancer and its treatment. Regular screening of these symptoms by the use of patient-reported outcomes (PROs) could increase timely recognition and adequate symptom management. Moreover, self-management interventions intend to enhance knowledge and skills and empower patients to better manage their disease and related problems. The objective of the Lymphoma InterVEntion (LIVE) trial is to examine whether feedback to patients on their PROs and access to a web-based, self-management intervention named Living with lymphoma will increase self-management skills and satisfaction with information, and reduce psychological distress. Methods/design The LIVE randomised controlled trial consists of three arms: (1) standard care, (2) PRO feedback, and (3) PRO feedback and the Living with lymphoma intervention. Patients who have been diagnosed with Hodgkin lymphoma, non-Hodgkin lymphoma, including chronic lymphocytic leukaemia, as registered in the Netherlands Cancer Registry in various hospitals will be selected for participation. Patients are invited via their haemato-oncologist 6 to 15 months after diagnosis. The PRO feedback includes a graphical overview of patients’ own symptom and functioning scores and an option to compare their scores with those of other patients with lymphoma and a normative population of the same age and sex. The Living with lymphoma intervention is based on cognitive behavioural therapy components and includes information, assignments, assessments, and videos. Changes in outcomes from baseline to 16 weeks, 12, and 24 months post intervention will be measured. Primary outcomes are self-management skills, satisfaction with information, and psychological distress. Secondary outcomes are health-related quality of life, illness perceptions, fatigue, and health care use. Discussion/design The results of the LIVE trial will provide novel insights into whether access to PRO feedback and the Living with lymphoma intervention will be effective in increasing self-management skills and satisfaction with information, and reducing distress. The LIVE trial is embedded in a population-based registry, which provides a unique setting to ascertain information on response, uptake, and characteristics of patients with lymphoma in web-based intervention(s). When effective, PRO feedback and Living with lymphoma could serve as easily and widely accessible interventions for coping with lymphoma. Trial registration Netherlands Trial Register, identifier NTR5953. Registered on 14 July 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1943-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lindy P J Arts
- Department of Research, Netherlands Comprehensive Cancer Organisation, PO Box 19079, 3501 DB, Utrecht, the Netherlands.
| | - Lonneke V van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation, PO Box 19079, 3501 DB, Utrecht, the Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Sanne W van den Berg
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Olga Husson
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Floortje Mols
- Department of Research, Netherlands Comprehensive Cancer Organisation, PO Box 19079, 3501 DB, Utrecht, the Netherlands.,CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | | | - Lidwine Tick
- Department of Internal Medicine, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Simone Oerlemans
- Department of Research, Netherlands Comprehensive Cancer Organisation, PO Box 19079, 3501 DB, Utrecht, the Netherlands.,CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| |
Collapse
|
14
|
Herst J, Crump M, Baldassarre F, MacEachern J, Sussman J, Hodgson D, Cheung M. Management of Early-stage Hodgkin Lymphoma: A Practice Guideline. Clin Oncol (R Coll Radiol) 2017; 29:e5-e12. [DOI: 10.1016/j.clon.2016.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/28/2016] [Accepted: 08/02/2016] [Indexed: 10/20/2022]
|
15
|
Behringer K, Goergen H, Müller H, Thielen I, Brillant C, Kreissl S, Halbsguth TV, Meissner J, Greil R, Moosmann P, Shonukan O, Rueffer JU, Flechtner HH, Fuchs M, Diehl V, Engert A, Borchmann P. Cancer-Related Fatigue in Patients With and Survivors of Hodgkin Lymphoma: The Impact on Treatment Outcome and Social Reintegration. J Clin Oncol 2016; 34:4329-4337. [DOI: 10.1200/jco.2016.67.7450] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Cancer-related fatigue occurs frequently in patients with Hodgkin lymphoma (HL) and has a major impact on their quality of life. We hypothesized that severe fatigue (sFA) might have an impact on patients’ treatment outcome and social reintegration. Methods Of 5,306 patients enrolled in the German Hodgkin Study Group’s fifth generation of clinical trials in HL (HD13, HD14, and HD15; nonqualified and older [> 60 years] patients excluded), 4,529 provided data on health-related quality of life. We describe sFA (defined as a score ≥ 50 on the 0 to 100 scale from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30) before and up to 9 years after therapy and analyze its impact on treatment outcome and social reintegration. Results The proportion of patients reporting sFA was 37% at baseline and ranged from 20% to 24% during follow-up. Baseline sFA was associated with significantly impaired progression-free survival and a trend to impaired overall survival, which can be overcome in patients receiving highly effective HL therapies as applied in our fifth-generation trials. Our analysis revealed a significant negative association of sFA and employment in survivors: 5 years after therapy, 51% and 63% of female and male survivors, respectively, with sFA were working or in professional education, compared with 78% and 90% without sFA, respectively ( P < .001 adjusted for age, sex, stage, baseline employment status, and treatment outcome). sFA was also associated with financial problems and the number of visits to a general practitioner and medical specialists. Conclusion sFA is an important factor preventing survivors from social reintegration during follow-up. This observation underscores the need to address fatigue as a significant diagnosis when treating patients with and survivors of cancer.
Collapse
Affiliation(s)
- Karolin Behringer
- Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg,
| | - Helen Goergen
- Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg,
| | - Horst Müller
- Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg,
| | - Indra Thielen
- Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg,
| | - Corinne Brillant
- Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg,
| | - Stefanie Kreissl
- Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg,
| | - Teresa Veronika Halbsguth
- Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg,
| | - Julia Meissner
- Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg,
| | - Richard Greil
- Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg,
| | - Peter Moosmann
- Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg,
| | - Oluwatoyin Shonukan
- Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg,
| | - Jens Ulrich Rueffer
- Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg,
| | - Hans-Henning Flechtner
- Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg,
| | - Michael Fuchs
- Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg,
| | - Volker Diehl
- Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg,
| | - Andreas Engert
- Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg,
| | - Peter Borchmann
- Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg,
| |
Collapse
|
16
|
Kreissl S, Mueller H, Goergen H, Mayer A, Brillant C, Behringer K, Halbsguth TV, Hitz F, Soekler M, Shonukan O, Rueffer JU, Flechtner HH, Fuchs M, Diehl V, Engert A, Borchmann P. Cancer-related fatigue in patients with and survivors of Hodgkin's lymphoma: a longitudinal study of the German Hodgkin Study Group. Lancet Oncol 2016; 17:1453-1462. [PMID: 27612583 DOI: 10.1016/s1470-2045(16)30093-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/24/2016] [Accepted: 04/15/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with Hodgkin's lymphoma might have persistent fatigue even years after treatment. However, knowledge of the development of fatigue persisting long after completion of treatment is limited. Therefore, we did a detailed analysis of fatigue in our first-line clinical trials for early-stage favourable (HD13 trial), early-stage unfavourable (HD14 trial), and advanced-stage (HD15 trial) Hodgkin's lymphoma. Beyond the description of fatigue from diagnosis up to 5 years after treatment, we aimed to assess any effect of patient characteristics, disease characteristics, or treatment characteristics on persistent fatigue. METHODS In this longitudinal study, we included patients with early-stage favourable, early-stage unfavourable, and advanced-stage Hodgkin's lymphoma from the HD13, HD14, and HD15 trials, respectively, aged between 18 and 60 years. Eligible patients for these trials had newly diagnosed, histologically proven Hodgkin's lymphoma, an Eastern Cooperative Oncology Group performance status of 2 or lower, HIV negativity, and absence of comorbidity disallowing protocol treatment. We used the fatigue scale of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire to assess fatigue from diagnosis up to 5 years after the end of treatment. The primary outcomes of interest in this study were fatigue scores in the second and fifth year after end of treatment. We estimated the effect of different disease, patient, and treatment characteristics on fatigue with multiple regression analyses and identified fatigue trajectories with growth mixture models. The regression analyses and growth mixture models used robust and full information maximum likelihood estimates to account for missing data. The HD13, HD14, and HD15 trials are registered as international standard randomised controlled trials, ISRCTN63474366, ISRCTN04761296, and ISRCTN32443041, respectively. FINDINGS The HD13 trial enrolled patients with early-stage favourable disease from Jan 28, 2003, to Sept 30, 2009; the HD14 trial enrolled patients with early-stage unfavourable disease from Jan 28, 2003, to Dec 23, 2009; and the HD15 trial enrolled patients with advanced-stage disease from Jan 28, 2003, to April 18, 2008. 5306 patients were enrolled in these trials. We analysed 4215 patients with any valid fatigue assessment up to 5 years after the end of treatment. Patients with higher tumour burden at diagnosis had more fatigue at baseline (mean fatigue score in HD13: 30·8 [SD 28·0]; in HD14: 39·8 [29·4], and in HD15: 49·0 [30·2]). Fatigue scores (FA) in the second year after the end of treatment were 28·5 (24·7) in HD13, 28·8 (24·4) in HD14, and 30·7 (24·4) in HD15; in the fifth year after the end of treatment FA was 30·8 (26·0) in HD13, 27·1 (24·8) in HD14, and 28·2 (24·9) in HD15. Predictors of fatigue in the second and fifth year after end of treatment were baseline fatigue (p<0·0001) and age as a continuous variable (p<0·0001). In addition to preceding fatigue and age, patient sex and Hodgkin's lymphoma specific risk factors at baseline did not consistently and significantly improve the prognosis of fatigue in the first, second, and fifth year after end of treatment. There was no significant effect of treatment on fatigue scores in the second and fifth year after treatment. INTERPRETATION Our findings show a high incidence of severe acute and persistent fatigue in Hodgkin's lymphoma survivors, which is largely independent of tumour stage and treatment. Our results contribute to a better understanding of fatigue in patients with Hodgkin's lymphoma and Hodgkin's lymphoma survivors and could inform development of urgently needed intervention strategies. FUNDING Deutsche Krebshilfe.
Collapse
Affiliation(s)
- Stefanie Kreissl
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Germany
| | - Horst Mueller
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Germany
| | - Helen Goergen
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Germany
| | - Axel Mayer
- Department of Data Analysis, Ghent University, Ghent, Belgium
| | - Corinne Brillant
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Germany
| | - Karolin Behringer
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Germany
| | | | - Felicitas Hitz
- Cantonal Hospital of St Gallen, St Gallen, Switzerland; SAKK Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | | | | | | | - Hans-Henning Flechtner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Michael Fuchs
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Germany
| | - Volker Diehl
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Germany
| | - Andreas Engert
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Germany
| | - Peter Borchmann
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Germany.
| | | |
Collapse
|
17
|
Henry-Amar M, Busson R. Does persistent fatigue in survivors relate to cancer? Lancet Oncol 2016; 17:1351-1352. [PMID: 27612584 DOI: 10.1016/s1470-2045(16)30156-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 05/09/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Michel Henry-Amar
- Centre de Traitement des Données du Cancéropôle Nord-Ouest, Centre François Baclesse, 14076 Caen cedex 05, France.
| | - Raphaël Busson
- Centre de Traitement des Données du Cancéropôle Nord-Ouest, Centre François Baclesse, 14076 Caen cedex 05, France
| |
Collapse
|
18
|
Linendoll N, Saunders T, Burns R, Nyce JD, Wendell KB, Evens AM, Parsons SK. Health-related quality of life in Hodgkin lymphoma: a systematic review. Health Qual Life Outcomes 2016; 14:114. [PMID: 27473596 PMCID: PMC4966803 DOI: 10.1186/s12955-016-0515-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 07/25/2016] [Indexed: 01/28/2023] Open
Abstract
Purpose Hodgkin Lymphoma (HL) is highly curable with well-established treatment regimens; however, the impact on patient’s health-related quality of life (HRQL) from diagnosis through survivorship is unclear. This systematic review aimed to describe the available literature on HRQL in HL, assess the quality of these studies, identify gaps in the literature and recommend further areas of research. Methods Following PRISMA guidelines, we performed a systematic review to include studies assessing the HRQL in HL patients. Articles identified through database searches were screened and data extracted. Quality was evaluated using a 6-point scale, adapted from published HRQL systematic reviews. Results Sixty five articles published between 1986 and 2015 met inclusion criteria. These included 53 (82 %) cross-sectional studies; 12 (18 %) longitudinal studies, including three embedded in randomized trials; and three additional longitudinal studies that began assessment at diagnosis. Study sample sizes of HL patients varied considerably with only five (42 %) longitudinal studies including more than 50 patients. Multidimensional HRQL was assessed in 45 studies, single HRQL domains in 22 studies, and symptoms, including fatigue, in 28 studies. Conclusions The majority of studies employed a cross-sectional design, enrolling HL survivors at least 10 years after the completion of therapy. Emphasis on HRQL following therapy may inform initial treatment decisions and long-term survivorship goals. We recommend that future research include prospective, longitudinal randomized designs across both treatment and time.
Collapse
Affiliation(s)
- Nadine Linendoll
- Tufts Cancer Center, Tufts Medical Center, 800 Washington Street, #245, Boston, MA, 02111, USA. .,Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA, 02111, USA.
| | - Tully Saunders
- Institute for Clinical Research and Health Policy, Tufts Medical Center, 800 Washington Street, #345, Boston, MA, 02111, USA
| | - Rebecca Burns
- Institute for Clinical Research and Health Policy, Tufts Medical Center, 800 Washington Street, #345, Boston, MA, 02111, USA
| | - Jonathan D Nyce
- Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA, 02111, USA
| | - Kristen B Wendell
- Advocate Lutheran General Hospital, 1775 Dempster St, Park Ridge, IL, 60068, USA
| | - Andrew M Evens
- Tufts Cancer Center, Tufts Medical Center, 800 Washington Street, #245, Boston, MA, 02111, USA.,Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA, 02111, USA
| | - Susan K Parsons
- Tufts Cancer Center, Tufts Medical Center, 800 Washington Street, #245, Boston, MA, 02111, USA.,Institute for Clinical Research and Health Policy, Tufts Medical Center, 800 Washington Street, #345, Boston, MA, 02111, USA.,Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA, 02111, USA
| |
Collapse
|
19
|
Seven-year follow-up for energy/vitality outcomes in early stage Hodgkin's disease patients treated with subtotal lymphoid irradiation versus chemotherapy plus radiation: SWOG S9133 and its QOL companion study, S9208. J Cancer Surviv 2016; 11:32-40. [PMID: 27405732 DOI: 10.1007/s11764-016-0559-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 06/25/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE We describe 7 years of follow-up for the energy/vitality outcome in early-stage Hodgkin's disease patients treated on a randomized clinical trial that compared subtotal lymphoid irradiation (STLI) with combined modality treatment (CMT) (SWOG 9133). Survivorship research questions involved the extent to which symptoms/side effects endured over a follow-up period of 7 years for this early-stage patient group. METHODS Two hundred thirty-nine patients participated in the quality of life (QOL) companion study (SWOG 9208) and completed the SF-36 vitality scale, SF-36 health perception item, Cancer Rehabilitation Evaluation System-Short Form (CARES-SF), and symptom distress scale. This paper reports vitality outcome results obtained from randomization, 6 months, and annually for 7 years. To assess changes in vitality over time, we used linear mixed models with patient as a random effect. RESULTS Patients receiving CMT had lower observed vitality at 6 months than did the STLI patients (p < .0001). However, beginning at year 1, vitality results did not differ significantly by treatment over the 5-year (p = .13) and 7-year (p = .16) follow-up periods. Vitality only slightly improved over baseline in either group after treatment. The results were similar after accounting for patterns of recurrence and missing data. CONCLUSIONS This study demonstrated that patients with early-stage Hodgkin's disease experience a short-term (at 6 months) decrease in vitality with treatment, which is more severe with CMT, but that after the first year, vitality scores were similar between the two treatment groups. Enduring fatigue results for patients receiving these therapies were not observed. Implications for cancer survivors These data provide comprehensive 7-year follow-up vitality information, an important symptom for early-stage lymphoma survivors.
Collapse
|
20
|
The Value of Patient Reported Outcomes and Other Patient-Generated Health Data in Clinical Hematology. Curr Hematol Malig Rep 2016; 10:213-24. [PMID: 26040262 DOI: 10.1007/s11899-015-0261-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
With cures and long-term survival rates increasing in hematologic malignancies, increased focus has been placed on gaining a better understanding of the patient experience from disease and treatment effects. This has been the basis for the utilization of patient reported outcomes (PRO) and other patient-generated health data (PGHD) in efforts to improve long-term health-related quality of life (HRQOL). This review will summarize the impact PROs have had on the evolving standard of care for patients with hematologic malignant conditions and will conclude with a template for the integration of PRO and PGHD to enhance the patient experience, using stem cell transplantation as an example.
Collapse
|
21
|
Anxiety and depression among haematological cancer patients attending treatment centres: prevalence and predictors. J Affect Disord 2014; 165:176-81. [PMID: 24882197 DOI: 10.1016/j.jad.2014.04.072] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/25/2014] [Accepted: 04/26/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study aimed to: (1) estimate the prevalence of anxiety and/or depression among haematological cancer patients attending treatment centres; and (2) explore the demographic, disease and treatment characteristics associated with anxiety and/or depression. METHODS A cross-sectional study was conducted with outpatients from three haematology clinics in Australia. Patients with a confirmed diagnosis of haematological cancer were approached by a research assistant while waiting for their appointment and invited to participate in the survey. Participants completed the Hospital Anxiety and Depression Scale (HADS) and self-reported demographic, disease and treatment characteristics. RESULTS Questionnaires from 304 participants were returned. Twenty-seven percent of patients reported anxiety and 17% reported depression. Specifically, 15% reported anxiety without depression, 5% reported depression without anxiety, and 12% reported comorbid anxiety and depression. Participants who had to relocate to receive treatment had almost three times the odds of reporting anxiety and/or depression compared to those who did not have to move. Former smokers also had significantly higher odds of reporting anxiety and/or depression. LIMITATIONS The HADS is likely to have produced some false positives and false negatives when compared with gold standard structured clinical interviews for assessing psychological morbidity. CONCLUSIONS Approximately 20% of haematological cancer patients attending outpatient clinics may experience clinically significant levels of anxiety and/or depression. Providing additional tailored support to patients who have had to relocate for treatment, and to former smokers, may help to reduce anxiety and depression among these subgroups.
Collapse
|
22
|
Health-related quality of life in Korean lymphoma survivors compared with the general population. Ann Hematol 2014; 93:1531-40. [PMID: 24947794 DOI: 10.1007/s00277-014-2091-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 04/14/2014] [Indexed: 11/12/2022]
Abstract
The objective of this study was to evaluate the health-related quality of life (HRQOL) of lymphoma survivors, to compare it with that of the general population, and to identify its predictors in lymphoma survivors. We enrolled 837 participants (mean age, 54.6 years; mean time since diagnosis, 6.3 years) with a history of Hodgkin's lymphoma (HL) (n = 58) or non-Hodgkin's lymphoma (NHL) (n = 779) who had been treated at any of three Korean hospitals from 1989 through 2010. For controls, we selected 1,000 subjects randomly from a representative Korean population. We administered the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and the Hospital Anxiety and Depression Scale. Overall, the HRQOL in both groups of survivors and the general population were comparable, but we observed clinically meaningful worse social functioning in NHL survivors (p < 0.001) and more severe fatigue in HL survivors (p < 0.001) than in the general population. Analysis of covariance revealed no clinically meaningful difference in HRQOL associated with age or sex. Survivors who received peripheral blood stem cell transplants showed clinically meaningful worse role (p = 0.001) and social (p < 0.001) functioning than those who were treated with first-line chemotherapy alone. In multivariate analyses, fatigue, depression, and financial difficulties emerged as the strongest predictors for almost all subscales of functioning and global quality of life. Interventions for alleviating fatigue, depression, and financial difficulties are needed to enhance the HRQOL of Korean lymphoma survivors.
Collapse
|
23
|
Roper K, Cooley ME, McDermott K, Fawcett J. Health-related quality of life after treatment of Hodgkin lymphoma in young adults. Oncol Nurs Forum 2014; 40:349-60. [PMID: 23803268 DOI: 10.1188/13.onf.349-360] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE/OBJECTIVES To describe changes in health-related quality of life (HRQOL) and to identify supportive care services used after treatment for Hodgkin lymphoma (HL) in young adults. DESIGN A longitudinal, repeated-measures study design was used to test the feasibility of data collection at the conclusion of treatment for HL and at one, three, and six months post-treatment. SETTING Participants were identified from two large comprehensive cancer centers in New England. SAMPLE 40 young adults with newly diagnosed HL were enrolled in the study prior to the completion of chemotherapy or radiation. METHODS Data were collected by interviews, standardized questionnaires, and medical record reviews. MAIN RESEARCH VARIABLES HRQOL variables defined as symptom distress, functional status, emotional distress, and intimate relationships; use of specific supportive care services; and baseline demographic and disease-related information. FINDINGS Results indicate that symptom distress improved at one month post-treatment and remained low at three and six months. Similarly, functional status improved at one month post-treatment. Only 13% of the sample had significant emotional distress at baseline, and this decreased to 8% over time. Patients placed high value on their intimate relationships (i.e., family and friends or sexual partners). A variety of supportive care services were used after treatment, the most common of which were related to economic issues. However, by six months post-treatment, services shifted toward enhancing nutrition and fitness. CONCLUSIONS The results from this study suggest that HRQOL in young adults with HL improved one-month post-treatment and that interest in using supportive care services was high. IMPLICATIONS FOR NURSING Facilitating the use of supportive care services at the end of cancer treatment appears to be an important part of helping young adults transition to survivorship. KNOWLEDGE TRANSLATION Supportive care services appear to be a vital component of the transition to survivorship and often change over time from an emphasis on economic issues to enhancing wellness through nutrition and fitness programs.
Collapse
Affiliation(s)
- Kristin Roper
- Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, USA.
| | | | | | | |
Collapse
|
24
|
Daniëls LA, Oerlemans S, Krol ADG, van de Poll-Franse LV, Creutzberg CL. Persisting fatigue in Hodgkin lymphoma survivors: a systematic review. Ann Hematol 2013; 92:1023-32. [PMID: 23728609 DOI: 10.1007/s00277-013-1793-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/13/2013] [Indexed: 12/24/2022]
Abstract
Hodgkin Lymphoma (HL) survivors are at risk for adverse psychosocial events as a result from cancer diagnosis and treatment. Fatigue is one of the most frequently reported long-term symptoms and is often reported to interfere with daily life. We conducted a systematic review to determine prevalence, severity and predisposing factors of fatigue in HL survivors. A literature search was conducted up to August 2012. Twenty-two articles comparing HL survivors with norm population data met all predefined selection criteria. Prevalence rates, levels of fatigue and clinical relevance of the results were determined. Prevalence of fatigue ranged from 11-76 % in HL survivors compared to 10 % in the general population. Mean fatigue scores were 5-13 % higher compared to the normative population; these findings were clinically relevant in 7 out of 11 studies. Increasing age was associated with higher levels of fatigue in HL survivors. Treatment modality and stage of initial disease were not associated with higher fatigue levels, while comorbidities or other treatment sequelae seemed to impact on the levels of fatigue. HL survivors are at serious risk for developing clinically relevant, long-term fatigue. The impact of patient and treatment characteristics on risk of fatigue is limited. Focus for future research should shift to the role of late-treatment sequelae and psychological distress symptoms.
Collapse
Affiliation(s)
- Laurien A Daniëls
- Departments of Clinical Oncology, K1-P, Leiden University Medical Center, Albinusdreef 2, Leiden, The Netherlands.
| | | | | | | | | |
Collapse
|
25
|
Khimani N, Chen YH, Mauch P, Recklitis C, Diller L, Silver B, Ng A. Influence of new late effects on quality of life over time in Hodgkin lymphoma Survivors: a longitudinal survey study. Ann Oncol 2013; 24:226-30. [DOI: 10.1093/annonc/mds243] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
26
|
Baptista RLR, Biasoli I, Scheliga A, Soares A, Brabo E, Morais JC, Werneck GL, Spector N. Psychometric properties of the multidimensional fatigue inventory in Brazilian Hodgkin's lymphoma survivors. J Pain Symptom Manage 2012; 44:908-15. [PMID: 22699090 DOI: 10.1016/j.jpainsymman.2011.12.275] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 11/29/2011] [Accepted: 12/01/2011] [Indexed: 11/21/2022]
Abstract
CONTEXT Fatigue is the most common symptom among Hodgkin's lymphoma survivors. OBJECTIVES To evaluate the psychometric properties of the Brazilian version of the Multidimensional Fatigue Inventory (MFI). METHODS The MFI was translated into Brazilian Portuguese using established forward-backward translation procedures, and the psychometric properties were evaluated in a sample of 200 Hodgkin's lymphoma survivors. The psychometric properties evaluated included internal consistency and construct validity. The MFI was administered along with the informed consent form. RESULTS The overall Cronbach's alpha coefficient for the 20 items was 0.84, ranging from 0.59 to 0.81 for each of the five scales. Correlations between items and scales ranged from 0.32 to 0.72. The factor analysis yielded a five-factor solution that explained 65% of the variance. The first factor merged the original "general fatigue" and "physical fatigue" scales, as has been previously reported. The second factor identified the original "mental fatigue" scale and the fifth factor identified the original "reduced activity" scale. Questions from the original "reduced motivation" scale were represented in both factors three and four. CONCLUSION The Brazilian version of the MFI showed satisfactory psychometric properties and can be considered a valid research tool for assessing cancer-related fatigue.
Collapse
Affiliation(s)
- Renata Lyrio R Baptista
- Hematology and Pathology Services, University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Ganz PA. Cancer Rehabilitation Evaluation System (CARES) and CARES-SF now publicly available. J Clin Oncol 2012; 30:4046-7. [PMID: 23008314 DOI: 10.1200/jco.2012.44.9926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
28
|
Ganz PA. “Doctor, Will the Treatment You Are Recommending Cause Chemobrain?”. J Clin Oncol 2012; 30:229-31. [DOI: 10.1200/jco.2011.39.4288] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Patricia A. Ganz
- Jonsson Comprehensive Cancer Center at the University of California Los Angeles, Los Angeles, CA
| |
Collapse
|
29
|
Contemporary quality of life issues affecting gynecologic cancer survivors. Hematol Oncol Clin North Am 2011; 26:169-94. [PMID: 22244668 DOI: 10.1016/j.hoc.2011.11.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Regardless of cancer origin or age of onset, the disease and its treatment can produce short- and long-term sequelae (ie, sexual dysfunction, infertility, or lymphedema) that adversely affect quality of life (QOL). This article outlines the primary contemporary issues or concerns that may affect QOL and offers strategies to offset or mitigate QOL disruption. These contemporary issues are identified within the domains of sexual functioning, reproductive issues, lymphedema, and the contribution of health-related QOL in influential gynecologic cancer clinical trials.
Collapse
|
30
|
Blaes AH, Ma L, Zhang Y, Peterson BA. Quality of life appears similar between survivors of indolent and aggressive non-Hodgkin lymphoma. Leuk Lymphoma 2011; 52:2105-10. [PMID: 21740095 DOI: 10.3109/10428194.2011.593270] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Few studies have examined the quality of life (QOL) in survivors of non-Hodgkin lymphoma (NHL). A total of 109 patients with NHL (58 aggressive [AGG], 51 indolent [IND]) completed two health-related QOL assessments using the Medical Outcomes Study 36-Item Short-Form Healthy Survey (MOS SF-36) and the Functional Assessment in Cancer Therapy - Fatigue (FACT-F). Scores between IND and AGG were compared using a two-sample t-test. Multiple linear regression was performed to account for any potentially explanatory variables. Overall, 70.6% had received chemotherapy and 55% had received immunotherapy. Some 17.6% of the IND group had received no therapy. The overall physical and mental component QOL scores of the SF-36 did not differ between survivors. Physical function in survivors of IND was significantly better when compared with that of AGG NHL. Our study reports a similar overall QOL between survivors of IND and AGG NHL. Physical function, however, may be more impaired in survivors of AGG NHL.
Collapse
Affiliation(s)
- Anne H Blaes
- Division of Hematology/Oncology/Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
| | | | | | | |
Collapse
|
31
|
Heutte N, Haioun C, Feugier P, Coiffier B, Tilly H, Ferme C, Gabarre J, Morschhauser F, Gisselbrecht C, Mounier N. Quality of life in 269 patients with poor-risk diffuse large B-cell lymphoma treated with rituximab versus observation after autologous stem cell transplant. Leuk Lymphoma 2011; 52:1239-48. [PMID: 21463114 DOI: 10.3109/10428194.2011.566951] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We aimed to assess quality of life (QoL) following front-line autologous stem cell transplant (ASCT) and the QoL relationship with rituximab maintenance, in patients with diffuse large B-cell lymphoma. Patients were then randomized to either one weekly rituximab injection for 4 weeks, or observation alone. Patients (n = 269) were given the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaires. Scales for all symptoms exhibited similar temporal patterns, with a marked increase, followed by a plateau after 1 year. The proportion of patients with a clinically significant improvement varied from 6% (constipation) to 56% (fatigue). Age, gender, and previous treatment-induced toxicities were not predictive of variations in QoL. Rituximab significantly reduced pain and symptom severity. Our results for QoL showed that patients experienced rapid recovery after ASCT in all the domains tested. Differences in QoL improvement with time were not connected with rituximab maintenance.
Collapse
Affiliation(s)
- Natacha Heutte
- Department of Statistics, Université de Caen-Basse Normandie, Caen, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Oerlemans S, Mols F, Nijziel MR, Lybeert M, van de Poll-Franse LV. The impact of treatment, socio-demographic and clinical characteristics on health-related quality of life among Hodgkin's and non-Hodgkin's lymphoma survivors: a systematic review. Ann Hematol 2011; 90:993-1004. [PMID: 21670973 PMCID: PMC3150657 DOI: 10.1007/s00277-011-1274-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 06/05/2011] [Indexed: 12/24/2022]
Abstract
Cancer survivors are at risk of experiencing adverse physical and psychosocial effects of their cancer and its treatment. Both Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL) survivors face problems that can affect their health-related quality of life (HRQoL). The authors systematically reviewed the literature on HRQoL among HL and NHL survivors. A PubMed and PsychINFO literature search for original articles published until May 2011 was performed. Twenty-four articles, which met the predefined inclusion criteria, were subjected to a quality checklist. HL survivors showed the most problems in (role) physical, social and cognitive functioning, general health, fatigue and financial problems. In addition, HL survivors treated with a combination of therapies, with older age and female sex reported worse HRQoL. NHL survivors showed the most problems in physical functioning, appetite loss, vitality and financial problems. Having had chemotherapy was negatively associated with HRQoL, but no differences in chemotherapy regimens were found. Furthermore, in NHL survivors not meeting public exercise guidelines, HRQoL is low but can be improved with more exercise. More research on the longitudinal comparison between HL and NHL survivors and healthy controls should be performed in order to better understand the long-term (side) effects of treatment on HRQoL and possibilities to alleviate these.
Collapse
Affiliation(s)
- Simone Oerlemans
- Research Department, Comprehensive Cancer Centre South, Eindhoven, The Netherlands.
| | | | | | | | | |
Collapse
|
33
|
Abstract
The prognosis of Hodgkin's lymphoma (HL) has markedly improved as management strategies evolved. In the modern era, less than 15% of patients with early-stage, non-bulky HL will relapse, and less than one third of those with advanced disease will relapse. As therapy for HL intensified, and as disease-related outcomes improved, the impact of the late effects of therapy has become increasingly important. There is a growing body of literature describing the late morbidity experienced by survivors of HL, including risks of second primary malignancy, cardiac disease, pulmonary disease, and endocrine dysfunction. Additionally, the impact of disease and treatment on psychosocial function and quality of life has been a subject of investigation, with survivors often suffering from impairment. An understanding of these risks and the management implications inherent to them is central to the care of survivors of HL.
Collapse
Affiliation(s)
- Shrujal S Baxi
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | | |
Collapse
|
34
|
Abstract
Although uncommon, breast cancer in young women is worthy of special attention due to the unique and complex issues that are raised. This article reviews specific challenges associated with the care of younger breast cancer patients, which include fertility preservation, management of inherited breast cancer syndromes, maintenance of bone health, secondary prevention, and attention to psychosocial issues.
Collapse
Affiliation(s)
- Courtney A Gabriel
- Abramson Cancer Center, University of Pennsylvania, 16 Penn Tower, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Susan M Domchek
- Abramson Cancer Center, University of Pennsylvania, 3 West Perelman Center, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| |
Collapse
|
35
|
Brandt J, Dietrich S, Meissner J, Neben K, Ho AD, Witzens-Harig M. Quality of life of long-term survivors with Hodgkin lymphoma after high-dose chemotherapy, autologous stem cell transplantation, and conventional chemotherapy. Leuk Lymphoma 2010; 51:2012-20. [PMID: 20858092 DOI: 10.3109/10428194.2010.513749] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In this study, we investigated the quality of life (QoL) of long-term survivors with Hodgkin lymphoma who received high-dose chemotherapy (HDCT) followed by peripheral blood stem cell transplantation (PBSCT). QoL of this group was compared with QoL of patients who were treated with conventional chemotherapy and with QoL of the healthy German population. Two standardized questionnaires, the EORTC QLQ-C30 and the EQ-5D, including the visual analogue scale (VAS) were applied. A total of 98 patients were included in the study, all of them treated in our institution. Thirty-seven patients who received HDCT with PBSCT between 1986 and 2007 were compared with 61 patients treated with conventional chemotherapy and supplementary radiation between 1998 and 2009. The median follow-up for the HDCT group was 11 years. Statistical analysis with the one-sample t-test shows a reduced QoL of both groups of patients compared to the healthy population. Compared to the group of patients who received conventional chemotherapy, there is a tendency towards reduced QoL in patients with HDCT in all of the three main categories of the EORTC-QLQ-C30. However, these differences were not statistically significant, with the exception of the subcategory of dyspnoea, which was worse in the group that was treated with BCNU containing high-dose protocols. We conclude that the negative impact of both HDCT and conventional therapy on the QoL of long-term survivors with Hodgkin lymphoma should not be underestimated and should lead to the development of less toxic therapy strategies.
Collapse
Affiliation(s)
- Juliane Brandt
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | | |
Collapse
|
36
|
Taskila T, de Boer AGEM, van Dijk FJH, Verbeek JHAM. Fatigue and its correlates in cancer patients who had returned to work--a cohort study. Psychooncology 2010; 20:1236-41. [PMID: 20821375 DOI: 10.1002/pon.1843] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 05/06/2010] [Accepted: 07/20/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Fatigue and other symptoms in cancer patients often interfere with social and occupational activities. Only a few studies, however, have examined relationship between fatigue and work-related outcomes. The aim of this study was to investigate which disease-related factors (treatment, diagnosis, cognitive dysfunction, depression, pain, and sleep disturbance) and work-related factors (work-load, work pressure, relationship to supervisor and colleagues, size of the company, and workplace accommodations) were related to fatigue in employed cancer survivors. METHODS Data was collected by questionnaire at 6 months (baseline) and 18 months (end of the follow-up) after cancer diagnosis from 135 people with different types of cancer who had returned to work at follow-up. Fatigue was measured with a four-item sub-scale of MFI. Scores ranged from 4 to 20, with higher scores indicating more fatigue. RESULTS The mean rate of general fatigue was 11.9 at baseline decreasing to 10.4 at the end of the follow-up (p<0.0001). At 6 months, higher work pressure (p = 0.02), physical workload (p<0.05) and less workplace accommodations (p = 0.03) were related to higher levels of fatigue. From disease-related factors, depression was associated with fatigue (p<0.0001) at baseline. Lack of workplace accommodations was the only factor affecting higher levels of fatigue at 18 months (p<0.001) and was also related to higher levels of depression at 6 months (p = 0.02) and at 18 months (p<0.001). CONCLUSIONS Lack of workplace accommodations was significantly related to fatigue at the end of the follow-up, which suggests that accommodations for illness can help to reduce fatigue and depression.
Collapse
Affiliation(s)
- T Taskila
- Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, The Netherlands.
| | | | | | | |
Collapse
|
37
|
Arden-Close E, Pacey A, Eiser C. Health-related quality of life in survivors of lymphoma: a systematic review and methodological critique. Leuk Lymphoma 2010; 51:628-40. [PMID: 20218810 DOI: 10.3109/10428191003587263] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Survival rates for Hodgkin lymphoma and non-Hodgkin lymphoma have improved in recent years. However, these improvements are associated with various late effects, which can compromise health-related quality of life (HRQoL). Improving HRQoL is a significant goal in oncology, and increasingly one of the primary outcomes in clinical trials, but is dependent on availability of reliable and sensitive measures. This review therefore aimed to: (i) identify and evaluate commonly used HRQoL measures; (ii) compare HRQoL in patients with lymphoma with the general population; and assess the association between (iii) HRQoL and different treatments; and (iv) HRQoL and demographic, medical, and psychological variables. Standardized systematic searches identified 18 eligible studies that included adult survivors of lymphoma and reported quantitative results by histological diagnosis. Information about design, sample, measures and findings was extracted from each study. Survivors of lymphoma experienced worse physical but comparable mental HRQoL to the general population. No conclusions could be drawn about the association between different treatments and HRQoL. Correlates of better HRQoL included younger age, educational level, being employed, male gender, earlier stage disease, not having co-morbid illnesses, and meeting public health exercise guidelines. Limitations of current research relating to research design, sample demographics, and reporting of descriptive statistics were identified. Given the increasing numbers of patients living with lymphoma, controlled studies using appropriate measures are required to determine the HRQoL consequences associated with the condition.
Collapse
Affiliation(s)
- Emily Arden-Close
- Department of Psychology, University of Sheffield, Sheffield S10 2TP, UK.
| | | | | |
Collapse
|
38
|
Johansson E, Wilson B, Brunton L, Tishelman C, Molassiotis A. Symptoms before, during, and 14 months after the beginning of treatment as perceived by patients with lymphoma. Oncol Nurs Forum 2010; 37:E105-13. [PMID: 20189909 DOI: 10.1188/10.onf.e105-e113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To explore occurrence of symptoms and relationships between them as perceived by patients with lymphoma before, during, and 14 months after the beginning of treatment. RESEARCH APPROACH Qualitative and longitudinal. SETTING A major oncology center in the United Kingdom. PARTICIPANTS 10 adult patients with lymphoma (3 women and 7 men) were recruited at treatment initiation. METHODOLOGIC APPROACH Semistructured audiotaped interviews were conducted with participants in median 15 days, 4 months, and 14 months after diagnosis. Analysis of the verbatim transcripts was inspired by interpretive description, which is a grounded approach articulating patterns emerging in relation to clinical phenomena. MAIN RESEARCH VARIABLES Symptoms. FINDINGS Symptoms commonly reported by patients in this sample were lack of energy, lymphadenopathy, weight loss, itching, pain, sadness, night sweats, sleeping difficulties, and hair loss. Co-occurring prediagnosis symptoms seem to have led patients to seek medical attention; co-occurring symptoms during treatment seem to have a cumulatively distressing effect. Several of the symptoms were described as interrelated, with one symptom leading to one or more other symptoms. CONCLUSIONS The data confirm a complex symptomatology in patients with lymphoma. In addition, the findings support that co-occurring symptoms may have a synergistic effect on patients' health outcomes and add new knowledge about relationships between symptoms from patients' perspectives. INTERPRETATION Illustrating symptoms and interrelationships between symptoms using diagrams may be useful to support communication as well as in identifying targets for symptom management.
Collapse
Affiliation(s)
- Eva Johansson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
| | | | | | | | | |
Collapse
|
39
|
Abstract
During the next decade, a rapid increase in the number of new cancer diagnoses in the population as well as a growing number of cancer survivors can be expected. Cancer is anticipated to exceed cardiovascular disease as the primary cause of mortality in the United States population. Despite efforts in tobacco control, the aging of the population and obesity epidemic will contribute toward the increasing incidence of cancer. Although oncology specialists will continue to play a critical role in the diagnosis and initial treatment of patients with cancer, primary care providers will need to play an expanding role in the early detection of cancer, as well as the follow-up, health promotion, and cancer surveillance that will be necessary after initial cancer treatment. Oncology specialists will need to do a better job coordinating the care of their patients with primary care providers, and work toward a shared care model that will optimize the quality of care delivered by the health care system. Cancer treatment summaries and survivorship care plans are an initial attempt to address the current fragmentation and lack of coordination in care that exist today. Cancer survivors are at risk for a wide range of late effects after their primary cancer treatment. Unfortunately, there is limited information about the exact incidence and prevalence of many physical late effects. For example, how many women given standard adjuvant chemotherapy with doxorubicin and cyclophosphamide for breast cancer at age 35 years will develop permanent amenorrhea after treatment, and be infertile? What is the excess risk of osteoporosis in a 70-year-old man receiving endocrine therapy for prostate cancer? What is the risk of coronary artery disease after mantle irradiation for Hodgkin lymphoma? Because of the limited database for many of these sequelae of treatment, clinicians have to keep all of these potential risks in mind as they interview a survivor, and develop a long-term management plan that focuses on symptomatic management and future chronic disease prevention. Until one has a better sense of the natural history of these late sequelae, as well as better information about who is at risk, focusing on a taking a cancer survivor-directed medical history may be the best detection tool that is available. Drawing on a shared care model, primary care providers should collaborate with oncology specialists to determine if cancer-specific laboratory and radiographic studies are indicated to determine if the patient has a cancer treatment-related late effect or cancer recurrence. Health promotion and aggressive management of comorbid conditions should be a standard of care for cancer survivors, as with other patients in the primary care practice. With the growing number of cancer survivors, as well as the recommendations of the IOM report directing research and policy on this subject (see Box 1), it is hoped that in the future a better evidence base to direct health care management in cancer survivors will be built up.
Collapse
Affiliation(s)
- Patricia A Ganz
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
| |
Collapse
|
40
|
Quality of Life and Symptoms of Anxiety and Depression of Patients Receiving Cancer Chemotherapy. Cancer Nurs 2010; 33:E1-E10. [DOI: 10.1097/ncc.0b013e3181b4adb5] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
41
|
|
42
|
Heutte N, Flechtner HH, Mounier N, Mellink WAM, Meerwaldt JH, Eghbali H, van't Veer MB, Noordijk EM, Kluin-Nelemans JC, Lampka E, Thomas J, Lugtenburg PJ, Viterbo L, Carde P, Hagenbeek A, van der Maazen RWM, Smit WGJM, Brice P, van Marwijk Kooy M, Baars JW, Poortmans P, Tirelli U, Leeksma OC, Tomšič R, Feugier P, Salles G, Gabarre J, Kersten MJ, Van Den Neste E, Creemers GJM, Gaillard I, Meijnders P, Tertian G, Reman O, Muller HP, Troncy J, Blanc M, Schroyens W, Voogt PJ, Wijermans P, Rieux C, Fermé C, Henry-Amar M. Quality of life after successful treatment of early-stage Hodgkin's lymphoma: 10-year follow-up of the EORTC–GELA H8 randomised controlled trial. Lancet Oncol 2009; 10:1160-70. [DOI: 10.1016/s1470-2045(09)70258-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
43
|
|
44
|
Holzner B, Kemmler G, Cella D, De Paoli C, Meraner V, Kopp M, Greil R, Fleischhacker WW, Sperner-Unterweger B. Normative data for functional assessment of cancer therapy--general scale and its use for the interpretation of quality of life scores in cancer survivors. Acta Oncol 2009; 43:153-60. [PMID: 15163163 DOI: 10.1080/02841860310023453] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The aims of this study were to derive population-based reference values for the Functional Assessment of Cancer Therapy Scale-General (FACT-G) and to investigate the impact of sociodemographic variables (e.g. age, sex, health status) on these quality of life (QOL) scores, and to compare the normative QOL scores with those of various groups of cancer survivors. A random sample of 2 000 members of the Austrian public were sent questionnaires containing the FACT-G and questions relating to demographic data and health status. A total of 968 questionnaires were returned giving an overall response rate of 50.6% (females 48.3%, age 49.3 +/- 16.8). Subjects with higher education reported higher QOL values; divorced and widowed persons had significantly lower QOL scores. Higher age was also associated with lower QOL scores. After bone marrow transplantation, patients generally showed lower QOL scores than the age- and sex-matched population-based sample, whilst in breast cancer survivors there was reduced QOL regarding social well-being. Survivors of Hodgkin's disease were found to have higher functional and social well-being scores than those of the general population sample. Sociodemographic variables should always be taken into consideration when interpreting QOL scores. Furthermore, unless patient data are compared with normative values, phenomena such as adaptation and response shift might be missed or misinterpreted.
Collapse
Affiliation(s)
- Bernhard Holzner
- Department of Biological Psychiatry, Innsbruck University Hospital, Innsbruck, Austria.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Høybye MT, Dalton SO, Christensen J, Larsen LR, Kuhn KG, Jensen JN, Carlsen K, Johansen C. Research in Danish cancer rehabilitation: social characteristics and late effects of cancer among participants in the FOCARE research project. Acta Oncol 2009; 47:47-55. [PMID: 17926146 DOI: 10.1080/02841860701418846] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Worldwide, the number of cancer survivors is increasing, owing to improvements in cancer therapy, resulting in an increased need to address the physical and mental sequelae of cancer. This paper introduces a Danish psychosocial cancer intervention and presents the baseline characteristics of the cancer survivors with respect to cancer site, sociodemographic variables, social network, lifestyle, self-rated health and the prevalence of cancer-related late effects. The study is part of the FOCARE research project, in which the long-term effects of the rehabilitation programme are evaluated systematically. The study is based on data from a self-administered baseline questionnaire filled in by 2 174 cancer survivors who registered for a 1-week, publicly paid rehabilitation retreat and were invited to participate in the FOCARE study in the period 25 November 2002 to 31 December 2005. The response rate at baseline was 86% (n = 1876). Most participants were younger women with breast cancer. They were generally well educated and working. The cancer survivors reported having comprehensive social networks and being physically active. Several cancer-related symptoms were reported by women with cancers at selected sites, of which fatigue was the most prevalent. More than half reported good-to-excellent self-rated health, while fair-to-poor health was reported by 40%, most of whom were survivors of lung (56%) and haematological (48%) cancers. The results indicate that Danish cancer survivors experience considerably reduced physical health, possibly as late physical effects of treatment. The problems reported by the cancer survivors suggest that cancer rehabilitation should include these aspects of living after cancer and take account of differences among cancer survivors with regard to cancer site, sex, age, family, working status and social position. These challenges might be addressed optimally in multi-dimensional rehabilitation programmes.
Collapse
|
46
|
Al-Majid S, Gray DP. A biobehavioral model for the study of exercise interventions in cancer-related fatigue. Biol Res Nurs 2008; 10:381-91. [PMID: 19114410 DOI: 10.1177/1099800408324431] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cancer-related fatigue (CRF) is a multifactorial, biobehavioral phenomenon experienced by the majority of persons with cancer. It has negative consequences on the individual's physical functioning and quality of life. An array of biological, psychobehavioral, and functional mechanisms contributes to its occurrence. A relatively large number of studies have examined the effect of physical exercise on CRF over the past few decades. Most of these studies did not specifically examine the effect of physical exercise on the biobehavioral mechanisms underlying CRF. For the most part, these studies have not been guided by a consistent theoretical model. Consequently, the mechanisms by which exercise may ameliorate CRF are not fully elucidated. A theoretical model incorporating fatigue-related biobehavioral variables that could be affected by physical exercise will allow for effective knowledge development in this area and could lead to the development and refinement of exercise protocols that specifically target these mechanisms. Thus, the purpose of this paper is to present a comprehensive theoretical model to guide future research on the effectiveness of exercise interventions in CRF. The proposed model incorporates the biological, psychobehavioral, and functional variables implicated in the induction of CRF.
Collapse
Affiliation(s)
- Sadeeka Al-Majid
- Department of Nursing, California State University, Fullerton, California 92834, USA.
| | | |
Collapse
|
47
|
Bhatia S, Robison LL. Cancer survivorship research: opportunities and future needs for expanding the research base. Cancer Epidemiol Biomarkers Prev 2008; 17:1551-7. [PMID: 18628407 DOI: 10.1158/1055-9965.epi-08-0490] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
48
|
Hodgson DC. Hodgkin Lymphoma: The Follow-Up of Long-Term Survivors. Hematol Oncol Clin North Am 2008; 22:233-44, vi. [DOI: 10.1016/j.hoc.2008.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
49
|
Abstract
BACKGROUND AND PURPOSE Fatigue is one of the most common and troubling symptoms in cancer survivors. In this paper we review information about cancer related fatigue in survivors of breast cancer and Hodgkin's disease, discuss some of the potential biological mechanisms for this problem in cancer survivors, and briefly discuss potential interventions. FINDINGS Cancer-related fatigue persists long after cancer treatments end, and is associated with more intensive treatments (combined chemotherapy and radiation therapy) in these cancers. Fatigue prior to the onset of treatment is a strong predictor of persistent fatigue. Studies in breast cancer survivors suggest elevated levels of pro-inflammatory cytokines in association with persistent fatigue, as well as abnormalities in the hypothalamic-pituitary axis. Psychosocial and physical activity interventions have been shown in some studies to alleviate fatigue. CONCLUSIONS Recognizing the syndrome of cancer-related fatigue is a high priority for the many cancer survivors who continue to experience this complaint as a chronic health problem.
Collapse
Affiliation(s)
- Patricia A Ganz
- UCLA Schools of Medicine and Public Health, Los Angeles, California, USA.
| | | |
Collapse
|
50
|
Abstract
Fatigue is a common and disabling symptom in breast cancer patients and survivors. A rather nebulous concept, fatigue overlaps with sleepiness and depressed mood. In this chapter, we cover methods for assessing fatigue; describe the occurrence of fatigue before, during and after initial treatment; present possible underlying mechanisms of fatigue; and, enumerate approaches to its treatment.
Collapse
Affiliation(s)
- Wayne A. Bardwell
- University of California, San Diego, Department of Psychiatry, San Diego, CA
- Moores University of California San Diego, Cancer Center, San Diego, CA
| | - Sonia Ancoli-Israel
- University of California, San Diego, Department of Psychiatry, San Diego, CA
- Moores University of California San Diego, Cancer Center, San Diego, CA
- Veterans Affairs San Diego Healthcare System, San Diego, CA
| |
Collapse
|