A high level of fatigue among long-term survivors of non-Hodgkin's lymphoma: results from the longitudinal population-based PROFILES registry in the south of the Netherlands

Abstract

The course of fatigue and quality of life in survivors of non-Hodgkin's lymphoma is unknown. The aims of this study were, therefore, to assess fatigue and quality of life in patients with non-Hodgkin's lymphoma following primary treatment, compare fatigue and quality of life in these patients with those of an age- and sex matched normative population to assess the severity of concerns and identify associations with fatigue of survivors who remained fatigued. The population-based Eindhoven Cancer Registry was used to select all patients diagnosed with non-Hodgkin's lymphoma from 1999-2009. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and the Fatigue Assessment Scale were completed once by 824 survivors of non-Hodgkin's lymphoma (80% response rate); 434 survivors completed these questionnaires again 1 year later. Survivors of non-Hodgkin's lymphoma reported more clinically relevant fatigue up till 10 years post-diagnosis compared to a normative population (P<0.001). Mean fatigue scores remained fairly stable over time (T1: x=28, SD=26; T2: x=30, SD=27, P=0.14): 22-28% of survivors reported deterioration, 19-23% reported improvement and 44-54% reported constant fatigue. Survivors who reported constant fatigue were more often diagnosed with stage IV disease and had more comorbid diseases. They were additionally more often female and divorced. Having comorbidities and being without a partner were also associated with constant fatigue in the normative population. In conclusion, six out of every ten responding non-Hodgkin's lymphoma survivors reported a high level of fatigue up till 10 years after diagnosis. Mean fatigue scores remained stable over time and survivors reporting constant fatigue more often had stage IV disease at diagnosis and comorbidities.

Figure 1.

(A) Differences in EORTC QLQ-C30 mean functioning and global quality of life scores between survivors of aggressive NHL (n=379), indolent NHL survivors (n=445) and an age- and sex-matched normative population (n=602) *P<0.001**P<0.001 and small clinically important differences. A higher score implies a better HRQOL. (B) Differences in EORTC QLQ-C30 mean symptom scores between survivors of aggressive NHL (n=379), indolent NHL (n=445) and an age- and sex-matched normative population (n=602)*P<0.001; **P<0.001 and small clinically important differences; ***P<0.001 and medium clinically important differences. A higher score indicates to more symptoms.

Figure 2.

Differences between EORTC QLQ-C30 fatigue scores of all NHL survivors (n=824) according to years survived since diagnosis and an age- and sex-matched normative population (N=602). All P<0.001 and small or medium clinically important differences. A higher score indicates more fatigue.