Impact of Severe Fatigue on Treatment Outcome and Social Reintegration in Hodgkin Lymphoma
Severe cancer-related fatigue was associated with poorer clinical outcomes in patients receiving standard therapies for Hodgkin lymphoma and poorer social reintegration, according to an analysis of data from German Hodgkin Study Group trials reported in the Journal of Clinical Oncology by Behringer et al.
Study Details
The study involved data from 4,529 patients aged < 60 years in the German Hodgkin Study Group’s fifth generation of clinical trials in Hodgkin lymphoma (HD13, HD14, and HD15; enrollment from January 2003 to September 2009). Severe fatigue was defined as a score ≥ 50 on the 0 to 100 scale of the European Organisation for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire Core 30 before and up to 9 years after therapy.
Fatigue and Outcomes
Severe fatigue was reported by 37% of patients at baseline and by 20% to 24% during follow-up. Among all patients and among patients receiving the most effective regimens in the trials, baseline severe fatigue was not associated with poorer progression-free or overall survival. However, severe fatigue vs no severe fatigue was associated with poorer progression-free survival (5-year progression-free survival = 87.1% vs 92.1%, hazard ratio [HR] = 1.52, P = .02) and overall survival (5-year overall survival = 95.1% vs 97.1%, HR = 1.65, P = .05) among patients receiving standard therapies in the trials.
Social Reintegration
Significantly fewer patients with severe fatigue at baseline (odds ratio [OR] = 0.67) and at 1 (OR = 0.33), 2 (OR = 0.32), and 5 years (OR = 0.29; all P < .001) were working full or part time or in professional education. At 5 years after therapy, 51% and 63% of female and male survivors with severe fatigue were working or in professional education vs 78% and 90% without severe fatigue (P < .001, adjusted for age, sex, stage, baseline employment status, and treatment outcome). Severe fatigue was also associated with financial problems and the number of visits to general practitioners and medical specialists.
The investigators concluded: “[Severe fatigue] is an important factor preventing survivors from social reintegration during follow-up. This observation underscores the need to address fatigue as a significant diagnosis when treating patients with and survivors of cancer.”
The study was supported by the Frauke Weiskam and Christel Ruranski-Stiftung.
Peter Borchmann, MD, of the German Hodgkin Study Group, University Hospital of Cologne, is the corresponding author of the Journal of Clinical Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
