SF-36

Quality of life in adolescent and young adult Hodgkin’s lymphoma survivors

CLINICAL PRESENTATION, DIAGNOSIS, AND MANAGEMENT OF LYMPHOID MALIGNANCIES , , , , ,

Ye.G. Arshanskaya1,2, S.V. Semochkin2,3, and A.G. Rumyantsev2,3

1 S.P. Botkin City Clinical Hospital, Moscow, Russian Federation

2 Federal Clinical-and-Research Center of Pediatric Hematology, Oncology, and Immunology n.a. Dmitriy Rogachev, Moscow, Russian Federation

3 N.I. Pirogov Russian National Research Medical University, RF Ministry of Health, Moscow, Russian Federation

ABSTRACT

Background. Deterioration of quality of life (QoL) and late complications of antitumor therapy for Hodgkin’s lymphoma (HL) are the important medical issues, since they mostly relate to young patients with a high life-expectancy.

Objective. The study was to compare QoL of HL survivors versus healthy young adults.

Methods. 56 (22 males and 34 females) HL survivors with a median age of 27.5 (range 22–41) were evaluated. For the purpose of comparison, 94 (44 males and 50 females) healthy subjects with a median age of 28.0 (range 22–46) were enrolled into the study of QoL. All HL survivors were treated in our hospital according to the modified pediatric protocol DAL-HD-90 in 1997–2007. QoL was assessed using the Short Form 36 (SF-36) which enabled generating 8 separate scales and 2 final scores (0 = worst possible health, 100 = best possible health). All survivors were in complete remission of HL for ³ 5 years.

Results. The HL survivors had the lower scores than the normal controls according to all scales and SF-36. Statistically significant differences were found in: general health — 53.4 (95 %CI 47.8–59.1) vs. 72.3 (68.8–75.8; p < 0,001), vitality — 54.7 (50.4–59.1) vs. 72.2 (69.3–75.2; p < 0.001), and mental health — 57.4 (53.5–61.4) vs. 71.7 (68.6–74.8; p < 0.001). The patients at the age ³ 18.5 years (ROC-curves; p = 0.047) at the time of HL diagnosis had poorer QoL when compared to younger patients with respect to: general health — 48.3 (41.3–55.2) vs. 60.9 (51.6–70.2; p = 0.027): vitality — 50.3 (44.7–55.9) vs. 61.1 (51.6–70.2; p = 0.013). The patients with the unfavorable events including relapse (n = 6) and second malignancy (n = 2) showed the lowest scores of QoL, especially in physical role performance [34.4 (2.6–71.3) vs. 79.7 (77.8–89.6; p = 0.002)] and emotional role performance [25.0 (7.5–57.5) vs. 77.8 (67.1–88.4; p < 0.001)]. Duration of remission, age at the QoL evaluation, gender, therapy intensity (2, 4, or 6 cycles of primary chemotherapy plus radiotherapy), Ann-Arbor stages, bulky disease, current married status, and education levels showed no significant influence on the QoL parameters.

Conclusion. Long-term HL survivors had poorer physical and mental QoL than the general population of young adults. The age at the time of LH diagnosis ³ 18.5 years was associated with significantly reduced QoL. The relapsed HL and second malignancies were mostly associated with the deterioration of physical and emotional role functioning that may indicate uncertainty of patients about future well-being.

Keywords: Hodgkin’s lymphoma, quality of life, adolescents, young adults, DAL-HD-90, SF-36

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REFERENCES

  1. Злокачественные новообразования в России в 2012 г. (заболева- емость и смертность). Под ред. А.Д. Каприна, В.В. Старинского, Г.В. Пе- тровой. М.: ФГБУ «МНИОИ им. П.А. Герцена» МЗ РФ, 2014. [Sostoyaniye onkologicheskoy pomoshchi naseleniyu Rossii v 2012 g. Pod red. A.D. Kaprina, V.V. Starinskogo, G.V. Petrovoy (Status of oncological care for population of Russia in 2012. Ed. by A.D.Kaprin, V.V. Starinsky, and G.V. Petrova). M.: FGBU MNIO im. P.A. Gertsena Minzdravsotsrazvitiya Rossii 2014.]
  2. Morton L.M., Wang S.S., Devesa S.S. et al. Lymphoma incidence patterns by WHO subtype in the United States, 1992–2001. Blood 2006; 107(1): 265–76.
  3. Румянцев А.Г., Птушкин В.В., Семочкин С.В. Пути улучшения ре- зультатов лечения злокачественных опухолей у подростков и молодых взрослых. Онкогематология 2011; 1: 20–30. [Rumyantsev A.G., Ptushkin V.V., Semochkin S.V. Approaches to improvement of treatment outcomes in adolescents and young adults with malignancies. Onkogematologiya 2011; 1: 20–30. (In Russ.)].
  4. Evens A.M., Hutchings M., Diehl V. Treatment of Hodgkin lymphoma: the past, present, and future. Nat. Clin. Pract. Oncol. 2008; 5(9): 543–56.
  5. Sasse S., Klimm B., Gorgen H. et al. Comparing long-term toxicity and efficacy of combined modality treatment including extended- or involved-field radiotherapy in early-stage Hodgkin’s lymphoma. Ann. Oncol. 2012; 23(11): 2953–9.
  6. Robison L.L., Green D.M., Hudson M. et al. Long-term outcomes of adult survivors of childhood cancer. Cancer 2005; 104(11): 2557–64.
  7. Shah A.B., Hudson M.M., Poquette C.A. et al. Long-term follow-up of patients treated with primary radiotherapy for supradiaphragmatic Hodgkin’s disease at St. Jude Children’s Research Hospital. Int. J. Radiat. Oncol. Biol. Phys. 1999; 44(4): 867–77.
  8. Феоктистов Р.И., Румянцева Ю.В., Абугова Ю.Г. и др. Результаты лечения детей и подростков с лимфомой Ходжкина: данные многоцентро- вого исследования. Онкогематология 2010; 1: 31–6. [Feoktistov R.I., Rumyantseva Yu.V., Abugova Yu.G., et al. Treatment outcomes in children and adolescents with Hodgkin’s lymphoma: data of multicenter study. Onkogematologiya 2010; 1: 31–6. (In Russ.)].
  9. Schellong G., Riepenhausen M., Bruch C. et al. Late valvular and other cardiac diseases after different doses of mediastinal radiotherapy for Hodgkin disease in children and adolescents: report from the longitudinal GPOH followup project of the German-Austrian DAL-HD studies. Pediatr. Blood Cancer 2010; 55(6): 1145–52.
  10. Демина Е.А., Пылова И.В., Шмаков Р.Г., Перилова Е.Е. Поздние ослож- нения терапии больных лимфомой Ходжкина. Совр. онкол. 2006; 1: 36–43. [Demina Ye.A., Pylova I.V., Shmakov R.G., Perilova Ye.Ye. Late complications of therapy in patients with Hodgkin’s lymphoma. Sovr. onkol. 2006; 1: 36–43. (In Russ.)]. 11. Ng A.K., LaCasce A., Travis L.B. Long-term complications of lymphoma and its treatment. J. Clin. Oncol. 2011; 29(14): 1885–92.
  11. Gil-Fernandez J., Ramos C., Tamayo T. et al. Quality of life and psychological well-being in Spanish long-term survivors of Hodgkin’s disease: results of a controlled pilot study. Ann. Hematol. 2003; 82(1): 14–8.
  12. Khimani N., Chen Y.H., Mauch P.M. et al. Influence of new late effects on quality of life over time in Hodgkin lymphoma Survivors: a longitudinal survey study. Ann. Oncol. 2013; 24(1): 226–30.
  13. Hjermstad M.J., Fossa S.D., Oldervoll L. et al. Fatigue in long-term Hodgkin’s disease survivors: a follow-up study. J. Clin. Oncol. 2005; 23(27): 6587–95.
  14. Ruffer J.U., Flechtner H., Tralls P. et al. Fatigue in long-term survivors of Hodgkin’s lymphoma; a report from the German Hodgkin Lymphoma Study Group (GHSG). Eur. J. Cancer 2003; 39(15): 2179–86.
  15. Новик А.А., Ионова Т.И. Руководство по исследованию качества жизни в медицине. Под ред. Ю.Л. Шевченко, 2-е изд. М.: Олма Медиагрупп, 2007. [Novik A.A., Ionova T.I. Rukovodstvo po issledovaniyu kachestva zhizni v meditsine. Pod red. Yu.L. Shevchenko, 2-e izd. (Manual on evaluation of quality of life in medicine. Ed by.: Yu.L. Shevchenko, 2nd ed.) M.: Olma Mediagrup, 2007]
  16. Давыдкин И.Л., Булгакова С.В., Шафиева И.А. Подходы к реаби- литации пациентов в Самарском областном межведомственном центре профилактики остеопороза. Аллергол. и иммунол. 2007; 8(1): 276. [Davydkin I.L., Bulgakova S.V., Shafiyeva I.A. Approaches to rehabilitation of patients in Samara regional interdisciplinary center for osteoporosis prevention. Allergol. i immunol. 2007; 8(1): 276. (In Russ.)].
  17. Semochkin S.V., Arshanskaya E.G., Bobkova M.M., Rumiantsev A.G. A long-term follow-up report on the modified pediatric protocol DAL-HD-90 for adolescents and young adults with Hodgkin lymphoma. Pediatr. Blood Cancer 2012; 59(6): 1042.
  18. Семочкин С.В., Лория С.С., Румянцев А.Г., Сотников В.М. Лечение лимфомы Ходжкина у подростков и молодых взрослых. Онкогематология 2008; 1: 18–26. [Semochkin S.V., Loriya S.S., Rumyantsev A.G., Sotnikov V.M. Management of Hodgkin’s lymphoma in adolescents and young adults. Onkogematologiya 2008; 1: 18–26. (In Russ.)].
  19. Ware J.E., Kosinski M. Interpreting SF-36 summary health measures: a response. Qual. Life Res. 2001; 10(5): 405–13.
  20. Van Tulder M.W., Aaronson N.K., Bruning P.F. The quality of life of longterm survivors of Hodgkin’s disease. Ann. Oncol. 1994; 5(2): 153–8.
  21. Loge J.H., Abrahamsen A.F., Ekeberg O., Kaasa S. Reduced healthrelated quality of life among Hodgkin’s disease survivors: a comparative study with general population norms. Ann. Oncol. 1999; 10(1): 71–7.
  22. Mols F., Vingerhoets A.J., Coebergh J.W. et al. Better quality of life among 10–15 year survivors of Hodgkin’s lymphoma compared to 5–9 year survivors: a population-based study. Eur. J. Cancer 2006; 42(16): 2794–801.