Quality of life in early stage Hodgkin lymphoma (HL) patients from the EORTC-GELA H8 Trial (20931): A post-treatment longitudinal study of 1,015 patients

Abstract

9535 Background: To study the change in post-treatment Quality of life (QOL) and fatigue in HL pts with favorable (H8-F) or unfavorable (H8-U) prognostic features (C Ferme et al, NEJM 2007;357:1916). Methods: In the H8-F, 3 MOPP-ABV plus involved-field radiotherapy (IFRT) were compared with subtotal nodal radiotherapy (STNI) alone. In the H8-U, 6 MOPP-ABV plus IFRT were compared with 4 MOPP-ABV plus IFRT and 4 MOPP-ABV plus STNI. Assessments were made using the EORTC QLQ-C30 (QOL) and the MFI-20 (Multidimensional Fatigue Inventory questionnaire). Questionnaires were given to pts in complete remission after end of treatment and at regular intervals for 5 years. Mixed models were used to assess reliable changes with time (0–6, 7–14, 15–21, 22–32, 33–47, ≥ 48 month). The impact of gender, age, prognostic group (H8-F vs H8-U), treatment arm and toxicity was also tested. Logistic regression on long term fatigue was performed to identify predictors among MFI-20 scales. Difference between countries were analyzed on Belgian, French and Dutch pts. P<0.01 was considered significant. Results: Of the 1,577 pts enrolled in the trial (median follow-up 92 months), 1,015 participated (4,877 forms). Improvement over time was observed for all scales except reduced motivation. Correlation was observed between: age and all scale changes except emotional functioning; gender (M<F) and physical functioning, emotional functioning, global QOL, fatigue, sexual functioning, and general fatigue; prognostic group (but not treatment arm) and social functioning; toxicity and reduced motivation. A country effect was observed: French pts had worse scores for emotional and social functioning, fatigue, and reduced motivation; in contrast, Dutch pts had worse scores for reduced activity. Belgian pts were intermediate except for reduced activity (higher scores). Finally, long-term fatigue was only influenced by age. Conclusions: QOL data from the re-adaptation of pts to normal life within 5 years after the end of therapy show substantial limitations. The impact of initial treatment is limited to its toxicity. However, fatigue remains of great concern in these pts with different results between countries. No significant financial relationships to disclose.