Age-related differences in quality of life among patients with diffuse large B-cell lymphoma.

Abstract

We read with great interest the article by Williams et al1 regarding the treatment of very elderly patients with diffuse large B-cell lymphoma (DLBCL). They concluded that the R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) conferred the longest survival and should also be considered for patients aged >80 years. However, they also stated that studies are needed to characterize the impact of DLBCL treatment on quality of life and to determine optimal R-CHOP dosing for very elderly patients. We very much agree that it is important to include the impact of cancer and its treatment on quality of life when making (shared) decisions concerning optimal treatment. We recently published 2 population-based studies on quality of life among patients with DLBCL, including the elderly.2, 3 We observed that patients aged 18 to 59 years, 60 to 75 years, and 76 to 85 years all reported significantly and clinically relevantly worse mean scores on physical, role, cognitive, and social functioning and reported more symptoms such as fatigue, dyspnea, and sleeping problems compared with their age-matched and sex-matched counterparts without cancer, regardless of the DLBCL treatment they received. Patients aged 18 to 59 years reported better physical functioning, global health status, and quality of life and reported fewer symptoms than patients aged 76 to 85 years. Although these differences between younger and older patients with DLBCL were of small clinical importance, it appeared that compared with the normative population, the largest impacts of cancer and its treatment were observed among the youngest age group. An obvious explanation might be that older patients receive less aggressive treatment, but also may have better coping strategies through more life experience and are likely to be faced with lower work-related and social demands and therefore experience less impact. Furthermore, a direct comparison between patients with DLBCL who underwent R-CHOP every 2 weeks (R-CHOP14) or every 3 weeks (R-CHOP21) demonstrated that patients who underwent R-CHOP14 reported more neuropathy concerns, fatigue, and a slowed-down feeling. Despite the fact that patients who underwent R-CHOP14 were on average younger (median age, 64 years [range, 21-78 years]) and had fewer comorbid conditions at the time of diagnosis, their global health status and quality of life were worse during follow-up compared with patients treated with R-CHOP21, who were on average older (median age, 69 years [range, 28-86 years]). Because 2 recent trials demonstrated no differences in overall survival among patients with DLBCL who underwent R-CHOP14 and R-CHOP21, the authors advised use of the R-CHOP21 schedule as the standard first-line treatment for DLBCL.4, 5 With respect to quality of life, it again appears that R-CHOP21 is the preferred schedule. Our population-based analyses demonstrated that quality of life is highly affected by cancer therapy and/or the cancer itself in both younger and elderly patients with DLBCL. The balance between quality and quantity of life is of utmost importance because a large number of patients have to cope with a lower functional status and symptoms not only directly after treatment but often for many years after diagnosis. Before treating the very elderly with aggressive treatment regimens, it is recommended that physicians discuss the advantages and disadvantages of treatment options and, most importantly, a patient's wish for quality of life at old age. No specific funding was disclosed. The authors made no disclosures. Simone Oerlemans, PhD Department of Research Netherlands Comprehensive Cancer Organisation (IKNL) Eindhoven, The Netherlands Center of Research on Psychology in Somatic Diseases (CoRPS) Tilburg University Tilburg, The Netherlands Marten R. Nijziel, MD, PhD Department of Internal Medicine/Hemato-Oncology Maxima Medical Center Eindhoven/Veldhoven, The Netherlands Lonneke V. van de Poll-Franse, PhD Department of Research Netherlands Comprehensive Cancer Organisation (IKNL) Eindhoven, The Netherlands Center of Research on Psychology in Somatic Diseases (CoRPS) Tilburg University Tilburg, The Netherlands