Abstract
BackgroundLong-term lymphoma survivors often complain of persistent fatigue that remains unexplained. While largely reported in Hodgkin lymphoma (HL), long-term fatigue is poorly documented in non-Hodgkin lymphomas (NHL). Data collected in two cohort studies were used to illustrate the fatigue level changes with time in the two populations.MethodsTwo cross-sectional studies were conducted in 2009–2010 (HL) and in 2015 (NHL) in survivors enrolled in European Organisation for Research and Treatment of Cancer (EORTC) Lymphoma Group and Lymphoma Study Association (LYSA) trials. The same protocol and questionnaires were used in both studies including the Multidimensional Fatigue Inventory (MFI) tool to assess fatigue and a checklist of health disorders. Multivariate linear regression models were used in the two populations separately to assess the influence of time since diagnosis and primary treatment, age, gender, education level, cohabitation status, obesity and health disorders on fatigue level changes. Fatigue level changes were compared to general population data.ResultsOverall, data of 2023 HL and 1619 NHL survivors with fatigue assessment available (99 and 97% of cases, respectively) were analyzed. Crude levels of fatigue were similar in the two populations. Individuals who reported health disorders (61% of HL and 64% of NHL) displayed higher levels of fatigue than those who did not (P < 0.001). HL survivors showed increasing fatigue level with age while in NHL survivors mean fatigue level remained constant until age 70 and increased beyond. HL survivors showed fatigue changes with age higher than those of the general population with health disorders while NHL survivors were in between those of the general population with and without health disorders.ConclusionsAmong lymphoma survivors progressive increase of fatigue level with time since treatment completion is a distinctive feature of HL. Our data suggest that changes in fatigue level are unlikely to only depend on treatment complications and health disorders. Investigations should be undertaken to identify which factors including biologic mechanisms could explain why a substantial proportion of survivors develop high level of fatigue.
Highlights
Long-term lymphoma survivors often complain of persistent fatigue that remains unexplained
The number of health disorders reported by the participants at the time of survivorship assessment were distributed in Hodgkin lymphoma (HL) and non-Hodgkin lymphomas (NHL) cases, i.e. 61.5 and 64.4%, respectively; those reporting three or more health disorders were 26.0 and 26.9%
Levels of fatigue adjusted on gender, age, education level, cohabitation status and obesity were influenced by the presence of health disorders at the time the survivorship assessment was made
Summary
Long-term lymphoma survivors often complain of persistent fatigue that remains unexplained. In up to one-third of patients fatigue can persist 10 years or more but studies reporting on fatigue in long-term cancer survivors are limited [4, 5]. Most of these studies concerned individuals who survived Hodgkin lymphoma (HL), few non-Hodgkin lymphomas (NHL) or both ([2, 3, 6,7,8,9,10,11,12,13], reviews in [14, 15]). Persistent fatigue was unrelated to primary treatment intensity and treatment given at relapse [14]
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