No Difference in Anxiety or Health-Related Quality of Life in NHL Patients Receiving Rituximab Maintenance vs Retreatment at Disease Progression


Key Points

  • There were no differences in anxiety or health-related quality of life between patients receiving rituximab maintenance or rituximab retreatment at disease progression.
  • An avoidant coping style was associated with increased anxiety and poorer health-related quality of life irrespective of treatment.

In an analysis among patients in the Eastern Cooperative Oncology Group (ECOG) E4402 trial (RESORT) reported in the Journal of Clinical Oncology, Wagner et al found no difference in anxiety or health-related quality of life in patients with low–tumor burden non-Hodgkin lymphoma who received maintenance rituximab (Rituxan) vs rituximab retreatment at disease progression.

Study Details

The study involved 253 patients in the trial who completed patient-reported outcome instruments at randomization to maintenance rituximab (n = 125) or rituximab retreatment (n = 128), at 3, 6, 12, 24, 36, and 48 months after randomization, and at rituximab failure. Illness-related anxiety was assessed by the 22-item Impact of Event Scale-Revised, general anxiety was assessed by the Hospital Anxiety and Depression Scale, illness-related coping style of active or avoidant was determined by an investigator-devised four-item instrument, and health-related quality of life was assessed with the Functional Assessment of Cancer Therapy-General (FACT-G).

No Differences for Maintenance vs Retreatment

There were no differences in illness-related anxiety between groups at any time point (P > .05) overall or by active or avoidant coping style. Illness-related anxiety and general anxiety significantly decreased over time in both groups. Health-related quality of life scores were generally stable, with no significant changes from baseline observed in either group.

Irrespective of treatment group, an avoidant coping style was associated with significantly higher rates of anxiety that exceeded clinical cutoffs at baseline (17.6% vs 4.0%), 3 months (17.3% vs 3.1%), 6 months (12.5% vs 3.3%), and 24 months (10% vs 0%; all P < .05) and worse health-related quality of life (P < .001). 

The investigators concluded: “Surveillance until [rituximab retreatment] at progression was not associated with increased anxiety compared with [maintenance rituximab], regardless of coping style. Avoidant coping was associated with higher anxiety and poorer [health-related quality of life].”

Lynne I. Wagner, PhD, of Northwestern University, Feinberg School of Medicine, is the corresponding author of the Journal of Clinical Oncology article.

The study was supported by the National Cancer Institute. For full disclosures of the study authors, visit

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