Fatigue- and health-related quality-of-life in anemic patients with lymphoma or multiple myeloma

Abstract

Purpose: The purpose of this study was to describe perceptions of fatigue in anemic patients with lymphoma or multiple myeloma (MM).

Methods: This is an observational multicenter study in a prospective cohort of lymphoma and MM patients with hemoglobin ≤ 11 g/dl managed under clinical practice. Fatigue was assessed at baseline and after 3 months using the PERFORM questionnaire, the Functional Assessment of Cancer Therapy-Fatigue, the linear analogue self-assessment, and visual analogue scale (VAS) scales.

Results: Two hundred and fifty patients (125 with lymphoma, 125 with MM) were included. Only 59.2 and 56.0% of patients received treatment for anemia, respectively. After 3 months, the hemoglobin levels increased significantly compared to baseline from 10.0 ± 1.2 to 11.5 ± 1.8 in the lymphoma group and from 9.9 ± 0.9 to 10.9 ± 1.5 g/dl, in the MM group (P < 0.001, both comparisons). At baseline, 87.2 and 84.8% of patients had fatigue (median intensity (VAS) 60 and 50). The overall PERFORM score decreased from 35.2 ± 15.2 to 32.0 ± 14.6 (P = 0.048), without differences between groups. No statistically significant changes were observed in the other scales. After multivariable adjustment, the only common independent factor associated to improvements in fatigue and health-related quality-of-life (HRQoL) was an increase in hemoglobin levels. The administration of curative intention treatment was also associated with HRQoL improvements. The psychometric properties of the PERFORM questionnaire in MM patients were good (Cronbach's alpha 0.87-0.98; intraclass correlation coefficients 0.84-0.89; effect sizes 0.59-0.96).

Conclusions: Almost all patients with lymphoma or MM diagnosed with anemia suffered from fatigue of moderate to severe intensity. Despite similar anemia supportive treatment, better correction of fatigue scores was observed in lymphoma patients after 3 months. Increases in hemoglobin were significantly associated to improvements in fatigue and HRQoL.

Keywords: Anemia; Fatigue; Lymphoma; Multiple myeloma; Quality-of-life; Questionnaire.