Long-term non-Hodgkin Lymphoma Survivors Research Articles

Long-term fatigue in survivors of non-Hodgkin lymphoma: The Lymphoma Study Association SIMONAL cross-sectional study.

Long-term survivors of non-Hodgkin lymphoma (NHL) must cope with treatment complications and late toxicities that affect their health-related quality of life. Little is known about the risk-to-benefit ratio of new agents like rituximab. The impact of treatment regimens and health disorders on long-term fatigue levels was investigated in a cross-sectional study. Two self-administered questionnaires, the 20-item Multidimensional Fatigue Inventory (MFI-20) and a Life Situation Questionnaire, were mailed in 2015 to NHL survivors enrolled onto 12 successive clinical studies (1993-2010) conducted by the Lymphoma Study Association. Private addresses were obtained for 3317 survivors, of whom 1671 (50%) returned the questionnaires. Severe fatigue was defined as MFI-20 scores ≥60 on dimension scales scored from 0 to 100. Linear regression models were used to assess factors that were linked to increased fatigue levels. The study population included 906 men and 765 women, and the median age was 64years (age range, 24-95years). Overall, 811 survivors had received cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP)-like chemotherapy, 518 had received high-dose CHOP, and 342 had undergone upfront autologous stem cell transplantation; 829 survivors also had received rituximab. In total, 1100 survivors (66%) reported 1 or more late health disorders. Severe fatigue was reported by 602 survivors (37%). Increased fatigue levels were associated (P<.001) with increased age, obesity, and the presence of health disorders, but not with initial treatment or rituximab. The survey confirms that high proportions long-term NHL survivors have severe fatigue. The results suggest that initial treatment and the receipt of rituximab have no influence on the development of long-term fatigue.

Sleep quality and health-related quality of life among long-term survivors of (non-) Hodgkin lymphoma in Germany.

This study investigated sleep quality and health-related quality of life (HRQOL) among long-term survivors of Hodgkin (HL) and non-Hodgkin lymphoma (NHL). The aim was to explore the impact of personal and health-related factors on sleep quality as well as associations between sleep quality and HRQOL. For the postal survey, participants with a minimum age of 18 years initially treated between 1998 and 2008 were recruited via the population-based cancer registry in Schleswig-Holstein, Northern Germany. Questionnaires included amongst others the Pittsburg Sleep Quality Index (PSQI) and the 36-Item Short Form Health Survey (SF-36v1). Descriptive and comparative statistics were performed. Additionally, a regression analysis was conducted to identify predictors of sleep quality. In total, we recruited 515 participants (398 NHL, 117 HL) with a mean age of 63.1 years. Approximately half of the survivors were classified as good sleepers. HRQOL scores differed between good and poor sleepers with lower scores in poor sleepers. In a prediction model, self-reported depression, exhaustion, higher age, inability to work, endocrinological disorders and female gender classified as predictors of sleep quality. This study highlights the impact of sleep quality on HRQOL in long-term survivors of NHL and HL. Thus, sleep quality should be routinely assessed during follow-up of cancer survivors with special attention to patients with potential risk factors.

Comparison of the impact of cancer between British and US long-term non-Hodgkin lymphoma survivors.

The aims of this study were to examine quality of life, using the Impact of Cancer version 2 (IOCv2), in British non-Hodgkin lymphoma (NHL) survivors and investigate differences between survivors in the UK and the USA. NHL survivors (326 UK and 667 US) completed the 37-item IOCv2 and psychological distress, fatigue and social support questionnaires. The IOCv2 showed good reliability in the British sample with higher internal consistency (Cronbach alpha 0.7-0.9) and no floor and ceiling effects. UK survivors showed significantly higher negative (p<0.001) and higher positive (p=0.003) IOC compared to US survivors. Younger survivors (p=0.003), those with shorter time since diagnosis (p<0.001) and with lower levels of social support (p=0.001), showed more negative IOC in both groups. Higher negative IOC was also significantly associated with fatigue (p<0.001) and depressive symptoms (p<0.001) in both countries. Higher positive IOC was associated with female gender (p<0.001), longer time since diagnosis (p=0.02), those diagnosed at later stage (p<0.05) and with greater social support (p=0.004). Whereas significantly lower positive IOC was associated with white ethnicity (p<0.001), higher education levels (p<0.05) and fatigue (p=0.001). The IOCv2 is reliable and applicable in UK and US populations. Both negative and positive IOC scores were higher in British compared to US survivors. However, in both countries, psychosocial factors consistently showed the greatest impact on QOL irrespective of clinical characteristics. Recognition and treatment of individuals with these risk factors is a high priority for improving QOL in long-term cancer survivors, as is the development of modular interventions aimed at increasing positive IOC as well as decreasing negative impact. The IOCv2 shows great potential both as a screening and assessment measure for examining cancer-related outcomes among survivors.

Fatigue in long-term non-Hodgkin lymphoma survivors.

239 Background: Fatigue is a common and distressing effect of cancer and its treatment, potentially affecting quality of life (QOL) for years after treatment. However, the prevalence and persistence of fatigue among long-term survivors of non-Hodgkin lymphoma (NHL) remains unknown. We aimed to identify demographic, clinical, and psychosocial risk factors for persistent fatigue in this population. Methods: In 2010, surveys were mailed to 682 NHL survivors who participated in a study 5 years earlier; respondents were, on average, 10.4 years post diagnosis. Standardized measures of QOL, symptoms, medical history, and demographic variables were reported at both time points. We defined significant fatigue conservatively as 0.5 standard deviations below the SF-36 scale’s cutoff for fatigue, and we defined persistent fatigue as significant fatigue at both time points. Chi-square, t-tests, and logistic regression were used to determine risk factors and predictors for persistent fatigue. Results: 30.8% (n = 172) and 33.0% (n = 186) of patients reported significant fatigue at time point 1 and 2, respectively; 20% of patients had persistent fatigue. Patients with persistent fatigue were more likely to report: female gender, income &lt; $30,000, less than college education, less exercise, active disease, chemotherapy, at least one recurrence of their disease, less social support, an average of 3.8 more comorbidities, and significantly more posttraumatic stress than those without persistent fatigue (all p &lt; .05). Logistic regression showed that education less than college, more comorbidities, less exercise, and more posttraumatic stress were independent predictors of persistent fatigue (all p &lt; .05). Conclusions: Fatigue plagues one-third of NHL survivors and persists in one-fifth of this population even years after diagnosis. These findings could inform clinical practice in NHL survivorship and highlight targets for intervention.

Fatigue in long-term non-Hodgkin lymphoma survivors.

Fatigue in long-term non-Hodgkin lymphoma survivors.

Quality of life among non-hodgkin lymphoma survivors

Aim. Little is known about change in quality of life among lymphoma survivors. We examined change over time in quality of life among long-term survivors of non-Hodgkin lymphoma and identified demographic, clinical and psychosocial risk factors for poor outcomes depending on the appearance of cardiovascular events.Methods and results. Fifty three cumulative clinical events occurred in 21 (25.6%) patients. Patients who had cardiovascular events reported significantly worse psychological well-being, general health, less vitality and health-related quality of life than patients who had not cardiovascular events. Chemotherapy was associated with quality of lives outcomes. Patients who were not diagnosed with cardiovascular events reported better social well-being than patients who were diagnosed with cardiovascular events. The observed differences in quality of life were significant only when they were measured with the QOL-CS, and not with the SF-36.Conclusion. The general health perceptions and vitality levels of non-Hodgkin lymphoma survivors with cardiovascular events remained significantly lower than those of patients without cardiovascular events.

Quality of Life Among Long-Term Survivors of Non-Hodgkin Lymphoma: A Follow-Up Study

Quality of Life Among Long-Term Survivors of Non-Hodgkin Lymphoma: A Follow-Up Study

Quality of life among long-term survivors of non-Hodgkin lymphoma: a follow-up study.

Little is known about change in quality of life (QOL) among long-term cancer survivors. We examined change over time in QOL among long-term survivors of non-Hodgkin lymphoma and identified demographic, clinical, and psychosocial risk factors for poor outcomes. Surveys were mailed to 682 lymphoma survivors who participated in a study 5 years earlier, when on average they were 10.4 years postdiagnosis. Standardized measures of QOL, perceptions of the impact of cancer, symptoms, medical history, and demographic variables were reported at both time points and examined using linear regression modeling to identify predictors of QOL over time. A total of 566 individuals participated (83% response rate) who were a mean of 15.3 years postdiagnosis; 52% were women, and 87% were white. One third of participants (32%) reported persistently high or improved QOL, yet a notable proportion (42%) reported persistently low or worsening QOL since the earlier survey. Participants who received only biologic systemic therapy reported improvement in physical health despite the passage of time. Older age, more comorbidity, and more or increasing negative and decreasing positive perceptions of cancer's impact were independent predictors of poor QOL. Lymphoma symptom burden, less social support, and having received a transplantation were related to negative perceptions of cancer's impact. Moderate to severe symptom burden, limited social support, or having received a transplantation should alert the clinician to potential need for supportive services. Perceptions of cancer's impact are associated with QOL cross-sectionally and longitudinally; modifying these perceptions may thus provide a strategy for improving QOL.

High Prevalence of Chronic Fatigue in Long Term Survivors of Childhood Acute Lymphoblastic Leukemia and Lymphoma

Abstract 4225 Introduction:Chronic fatigue is a frequent and distressing late effect after successful cancer treatment. However, few studies have included survivors of childhood cancers. Aims:The primary aim of the study was to assess the prevalence of fatigue in long-term survivors of childhood acute lymphoblastic leukemia (ALL), non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL), and to compare with the Norwegian general population. A secondary aim was to explore the association between cardiac or pulmonary late effects and fatigue in long-term survivors after NHL and HL. Material and method:This population-based cross-sectional study included tumor-free adult survivors of childhood ALL, NHL and HL diagnosed between 1970 and 2002 at an age of <19 years with at least 5 years follow-up time. The enrolled patients underwent extensive biochemical and clinical investigation including echocardiography and estimation of lung volumes and diffusion capacity. Clinical information was retrieved from the patient records. Chalder′s fatigue questionnaire (FQ) was used to assess fatigue. Chronic fatigue (CF) was defined as a substantially increased level of fatigue with duration of more than 6 months. 1423 age and gender matched individuals from the general Norwegian population served as controls. Results:A total of 290 patients completed the questionnaire (ALL 151, NHL 47, HL 92). Median age (range) at assessment was 29.9 (18.3–54.5) years. Median follow-up time from diagnosis was 21.3 (6.9–39.2) years. The overall prevalence of CF was 27% (ALL 23%, NHL 30%, HL 34%), as compared to 8.4% among the controls (p>0.001). There was a tendency towards a higher prevalence of CF by increasing age (32% among subjects aged ≥30 years at follow-up vs. 22% in subjects aged<30 years, p=0.063). This was most pronounced among the ALL survivors (36% among subjects aged ≥30 years years at follow-up vs. 13% among subjects aged <30 years, p=0.001). In ALL survivors, older age at diagnosis was associated with higher prevalence of CF (15% among subjects aged <6 years at diagnosis vs. 32% among subjects aged ≥6 years, p= 0.012). Indeed, among all survivors ≥6 years at diagnosis, the ALL group had a similar prevalence of CF as the two other diagnostic groups; 32%. No association was found between CF and gender, time from diagnosis, radiotherapy, cumulative anthracycline dose, body mass index, proBNP or hypothyreosis. Among the lymphoma survivors the presence of B-symptoms at diagnosis tended to be associated with CF (Presence: CF 48% vs. Absence: CF 29%, p=0.058). In long-term survivors of NHL and HL, no association was found between CF and aortic valve disease, total lung capacity and diffusion capacity. Conclusions:Compared to the general population the prevalence of CF is 3-fold increased in long-term survivors of childhood leukemia and lymphoma. The prevalence is highest in HL (34%), but, rather surprisingly, even ALL survivors have a high occurrence of CF (23%). The lack of association between CF and somatic co-morbidity or dysfunction warrants future studies exploring the etiology of CF in long-term survivors. Disclosures:No relevant conflicts of interest to declare.

Post-Traumatic Stress Symptoms in Long-Term Non-Hodgkin's Lymphoma Survivors: Does Time Heal?

Little is known about the trajectory of post-traumatic stress disorder (PTSD) symptoms in cancer survivors, despite the fact that such knowledge can guide treatment. Therefore, this study examined changes in PTSD symptoms among long-term survivors of non-Hodgkin's lymphoma (NHL) and identified demographic, clinical, and psychosocial predictors and correlates of PTSD symptomatology. Surveys were mailed to 682 NHL survivors who participated in an earlier survey and now were at least 7 years postdiagnosis. Information was obtained regarding PTSD symptoms, positive and negative perceptions of the cancer experience (ie, impact of cancer), and other potential correlates of PTSD. A total of 566 individuals participated (83% response rate) with a median of 12.9 years since diagnosis; respondents were 52% female and 87% white. Although half (51%) of the respondents reported no PTSD symptoms and 12% reported a resolution of symptoms, more than one-third (37%) reported persistence or worsening of symptoms over 5 years. Survivors who reported a low income, stage ≥ 2 at diagnosis, aggressive lymphoma, having received chemotherapy, and greater impact of cancer (both positive and negative) at the initial survey had more PTSD symptoms at follow-up. In multivariable analysis, income and negative impacts of cancer were independent predictors of PTSD symptoms. More than one-third of long-term NHL survivors experience persisting or worsening PTSD symptoms. Providers should be aware of enduring risk; early identification of those at prolonged risk with standardized measures and treatments that target perceptions of the cancer experience might improve long-term outcomes.

Post-Traumatic Stress Symptoms in Long-Term Non-Hodgkin's Lymphoma Survivors: Does Time Heal?

Post-Traumatic Stress Symptoms in Long-Term Non-Hodgkin's Lymphoma Survivors: Does Time Heal?

Quality of life among long‐term non‐Hodgkin lymphoma survivors

The objective of this population-based study was to document the long-term effects (5-15 years postdiagnosis) of non-Hodgkin lymphoma and its treatment on health-related quality of life (HRQL) and social problems. The population-based Eindhoven Cancer Registry was used to select all patients who were diagnosed with non-Hodgkin lymphoma from 1989 to 1998. Three hundred sixty patients were invited to complete the 36-item Short Form Health Survey (SF-36) and the Quality of Life-Cancer Survivors questionnaire, and 294 patients (82%) responded. Patients who had received chemotherapy reported significantly worse psychological and social well-being and health-related quality of life (HRQL) than patients who had not received chemotherapy. Radiotherapy and watchful waiting were not associated significantly with HRQL outcomes. Patients who were diagnosed from 10 to 15 years earlier reported better social well-being than patients who were diagnosed from 5 to 9 years earlier. Compared with an age-matched, normative sample from the general population, patients reported significantly worse general health and less vitality, but they reported less bodily pain. Practical problems were reported with work (41%), obtaining health care insurance (6%) and life insurance (15%), and obtaining a home mortgage (22%). From 5 to 15 years after diagnosis, the general health perceptions and vitality levels of non-Hodgkin lymphoma survivors remained significantly lower than those of their peers in the of general population. In addition, survivors faced practical problems with work and finances that deserve additional attention during the period of rehabilitation.

Secondary Lung Tumors in Hematological Patients

Advances made in the field of chemotherapy and radiotherapy have considerably increased the survival of patients with Hodgkin's disease (HD), non-Hodgkin's lymphoma (NHL), and chronic lymphocytic leukemia (CLL). Unfortunately, these antiblastic therapies have also increased the risk of late complications such as second tumors, especially second lung cancers. Although the role of ionizing radiations in carcinogenesis is now clear, less is known about the damage caused by chemotherapy, immunodeficiency induced by drugs or hematological pathologies, and cigarette smoking. In HD, the relative risk (RR) of second lung cancer increases considerably in relation to the dose of ionizing radiation given to the patient, with an RR of 9.6 when more than 9 Gy are administered. Some studies have reported a significantly higher risk of second lung cancers in smokers compared with nonsmokers ( p = .03). The role of chemotherapy in the development of second lung cancers has yet to be determined. Although some authors correlate a greater risk with an increased number of chemotherapy cycles, others maintain that chemotherapy increases the risk of second lung cancer only if associated with cigarette smoking. Even less is known about the correlation between NHL and second lung cancer. Although the RR is higher in long-term NHL survivors than in healthy individuals (RR = 1.36), the heterogeneity of histotype and treatment does not permit us to confirm a correlation with chemotherapy and smoking. Conversely, in CLL, the development of second lung cancer appears to be linked to the immunodeficiency that accompanies this hematological malignancy. This is confirmed by the identical RR (1.66) for CLL patients subjected to chemotherapy and for those who have only follow-up.