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. 2014 Feb 18;110(4):868-74.
doi: 10.1038/bjc.2013.779. Epub 2014 Jan 16.

Chronic fatigue in Hodgkin lymphoma survivors and associations with anxiety, depression and comorbidity

L A Daniëls  1 , S Oerlemans  2 , A D G Krol  1 , C L Creutzberg  1 , L V van de Poll-Franse  2
Affiliations

Chronic fatigue in Hodgkin lymphoma survivors and associations with anxiety, depression and comorbidity

L A Daniëls et al. Br J Cancer. .

Abstract

Background: Fatigue is a frequent and persistent problem among Hodgkin lymphoma (HL) survivors. We investigated the prevalence of clinically relevant fatigue in HL survivors and the relation between fatigue and anxiety and depression.

Methods: Fatigue was measured through the generic European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) and Fatigue Assessment Scale (FAS). Anxiety and depression were measured with the Hospital Anxiety and Depression Scale. Questionnaires were mailed to 267 HL survivors. Results were compared with a Dutch age-matched normative population.

Results: Response rate was 68% (median age 46 years, mean time since diagnosis 4.6 years). Prevalence of fatigue was significantly higher among HL survivors than in the norm population (FAS 41% vs 23%, QLQ-C30 43% vs 28%), as were fatigue levels. There was a significant association between fatigue, anxiety and depression. Of the HL survivors with high symptom levels of depression, 97% also reported fatigue. In multivariate analysis, depression was strongly associated with high levels of fatigue and, to a lesser extent, anxiety and comorbidity.

Conclusions: Prevalence rates of fatigue are significantly higher in HL survivors than in the general population and differences are clinically relevant. Depression and anxiety were strongly associated with high levels of fatigue. Reducing fatigue levels by treatment of depression and anxiety should be further explored.

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Figures

Figure 1
Figure 1
Prevalence of caseness of fatigue. Prevalence of caseness of fatigue according to fatigue subscale of the EORTC QlQ-C30 and FAS, and caseness of anxiety or depression according to the HADS scale for both HL survivors and the age-matched Dutch population. The two last columns describe the prevalence of combined fatigue and anxiety or depression among all HL survivors and of the norm population. *P<0.05; **P<0.001.
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