Longitudinal Analysis of Health-Related Quality of Life in Patients With Hodgkin Lymphoma

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A longitudinal analysis of health-related quality of life in patients from German Hodgkin Study Group trials, reported in the Journal of Clinical Oncology by Kreissl et al, showed a “high and persistent” amount of health-related quality-of-life deficits in survivors of Hodgkin lymphoma. The deficits appeared to be independent of the treatment received.

Study Details

The study included data from 4,215 patients age 18 to 60 at diagnosis with any health-related quality-of-life assessment up to 5 years after treatment in the German Hodgkin Study Group trials HD13, HD14, and HD15. Health-related quality of life was analyzed using all functional and symptom scales of the EORTC Quality of Life Questionnaire C30, including deviations from reference values.

Key Findings

Higher tumor burden at diagnosis was associated with impaired baseline scores in many health-related quality-of-life domains. Health-related quality of life worsened in most domains during treatment, with fatigue, role functioning, and social functioning being the most severely affected.

In the first year after treatment, mean scores of all functioning and symptom scales improved vs respective scores during treatment, with fatigue, role functioning, and social function showing moderate recovery. In the first year of follow-up, financial issues were the most affected domain in all three trials.

During longer follow-up, cognitive, emotional, role, and social functioning, as well as fatigue, dyspnea, sleep, and financial problems, were severely and persistently affected; from year 2 on, mean deviations from reference values for these domains ranged between 12 and 29 points, with 10 points commonly considered as a margin of clinical relevance.

In the fifth year after therapy, cognitive, emotional, role, and social function scales, as well as fatigue, dyspnea, sleep, and financial problems, remained severely and persistently affected, with deviations from reference values ranging from 14 to 23 points. Such deficits were not observed in the domains of physical functioning, pain, nausea, appetite, diarrhea, and constipation.

In general, health-related quality of life remained largely stable from 2 years after the end of treatment through 5 years. In all three trials, health-related quality of life domains at 2 and 5 years after therapy were significantly influenced by baseline scores and age, but not by randomly assigned treatments or disease stage.

Among all symptoms, fatigue was most closely correlated with all functioning and other symptom scales.

The investigators concluded, “Our results show a high and persistent amount of different health-related quality of life deficits in survivors of Hodgkin lymphoma that are largely independent of the applied chemotherapies. Our analysis underscores the high, unmet medical need of these rather young survivors of Hodgkin lymphoma regarding the psychosocial adverse effects of the cancer experience.”

Peter Borchmann, MD, PhD, of the First Department of Internal Medicine, German Hodgkin Study Group, University Hospital of Cologne, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by Deutsche Krebshilfe and by the Frauke Weiskam + Christel Ruranski-Stiftung. For full disclosures of the study authors, visit

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