The impact of post-treatment severe fatigue on patient outcome and social reintegration

Behringer, K. from the German Hodgkin Study Group, University Hospital of Cologne, Germany,  and colleagues reported the results of the first large prospective study of the effects of fatigue in HL survivors. The study included 3,759 participants who completed QLQ-S (Quality of Life Questionnaire for Survivors) was on the impact of before and post-treatment severe fatigue (sFA) in HL patients on social integration and overall outcome. The study was published in the Journal of Clinical Oncology in October 2016.

Highlights:

• 37% HL patients reported sFA at baseline
• Baseline sFA was a significant risk factor for 5 year PFS 87.1% (sFA) vs 92.1% (non-sFA) in standard treatment groups
• But baseline sFA was not a significant risk factor for 5 year PFS and OS with more effective therapies
• Patients with sFA before treatment had significantly lower 5 year employment status sFA = Male: 51% Female: 63% vs. non-sFA = M: 78% F: 90%
• sFA associated with increased annual visits to GPs (4.0 vs 7.4/year) and medical specialists (4.3 vs 6.8/year) 5 years post-treatment

Conclusions:

The results of this prospective study showed that there was a negative association between severe fatigue at baseline and patients’ social reintegration after 5 years. Severe fatigue was also associated with higher number of visits to health care professionals. However, the effect of baseline sFA can be overcome if more effective HL therapies are used.

 Abstract:

Cancer-Related Fatigue in Patients With and Survivors of Hodgkin Lymphoma: The Impact on Treatment Outcome and Social Reintegration

Karolin Behringer et al.

Purpose: Cancer-related fatigue occurs frequently in patients with Hodgkin lymphoma (HL) and has a major impact on their quality of life. We hypothesized that severe fatigue (sFA) might have an impact on patients’ treatment outcome and social reintegration.

Methods: Of 5,306 patients enrolled in the German Hodgkin Study Group’s fifth generation of clinical trials in HL (HD13, HD14, and HD15; nonqualified and older [> 60 years] patients excluded), 4,529 provided data on health-related quality of life. We describe sFA (defined as a score ≥ 50 on the 0 to 100 scale from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30) before and up to 9 years after therapy and analyze its impact on treatment outcome and social reintegration.

Results: The proportion of patients reporting sFA was 37% at baseline and ranged from 20% to 24% during follow-up. Baseline sFA was associated with significantly impaired progression-free survival and a trend to impaired overall survival, which can be overcome in patients receiving highly effective HL therapies as applied in our fifth-generation trials. Our analysis revealed a significant negative association of sFA and employment in survivors: 5 years after therapy, 51% and 63% of female and male survivors, respectively, with sFA were working or in professional education, compared with 78% and 90% without sFA, respectively (P < .001 adjusted for age, sex, stage, baseline employment status, and treatment outcome). sFA was also associated with financial problems and the number of visits to a general practitioner and medical specialists.

Conclusion: sFA 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.