Longitudinal Evaluation of Quality of Life and Fatigue In Hodgkin Lymphoma Patients

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 935-935
Author(s):  
Peter Borchmann ◽  
Horst Müller ◽  
Corinne Brillant ◽  
Karolin Behringer ◽  
Teresa Halbsguth ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Overall Survival ◽  
Hodgkin Lymphoma ◽  
Reference Values ◽  
Longitudinal Evaluation ◽  
Severe Fatigue ◽  
Advanced Stages

Abstract Abstract 935 Background: Long term impairment of quality of life (QoL) and elevated fatigue levels in Hodgkin Lymphoma (HL) survivors have been reported. However, few longitudinal data and no conclusive knowledge on components and determinants of QoL exist so far. Therefore, the German Hodgkin Study Group (GHSG) assessed the patients` QoL within the prospectively randomized studies HD10-12 for a detailed longitudinal evaluation of QoL and fatigue. Methods: QoL was assessed with a psychometrically proven questionnaire (QLQ-S) which contains the EORTC QLQ-C30 among other scales and items. Patients answered the questionnaires before, during, and at the end of therapy and at regular follow-up visits. For all QLQ-C30 functional scales and fatigue, longitudinal courses up to 27 months from diagnosis are given with means and 95%-confidence intervals. Reference values from a German control population were used for interpretation of the results. Components and determinants of QoL were analyzed with special modeling software (MPlus) which allows for full information maximum likelihood estimation of multivariate longitudinal models in the presence of missing data. The predictive value of fatigue at baseline for progression free survival and overall survival was tested in Cox proportional hazards analyses together with other known risk factors. Results: 4,160 patients were included in HD10-12, and 3,208 are evaluable for this analysis (total of 15,722 assessments). Before therapy, HL patients had clearly poorer mean scores in each QoL scale when compared to the German reference population. All scales at baseline were negatively influenced by gender (females) and more advanced disease. Before therapy age ≥50 years was negatively related to physical functioning and cognitive functioning, but positively to social functioning. After a decrease of QoL during chemotherapy, all scales showed considerable improvement. However, usually long term QoL remained below normal reference values and this was most pronounced in patients ≥50 years of age and advanced stages. A QoL model with three factors (physical, mental, and social) showed very good fit (RMSEA<.05) and high stability of QoL already 12 months after diagnosis. No relevant effect of the type of treatment could be detected. Overall, 44.7% of patients never experienced severe fatigue ≥50 (relative scale from 0–100), and 17.4% had fatigue only temporarily during treatment, and 15.1% had severe fatigue before therapy which vanished after therapy. In addition, 6.8% of patients developed severe long term fatigue without being severely fatigued before, and 6% had permanently severe fatigue. Cox regression for overall survival revealed that severe fatigue at baseline is a significant, strong and independent risk factor for death from any cause (p<.05, HR= 1.5). Other significant risk factors for OS included age, infradiaphragmatic nodes, and large mediastinal mass. In contrast, gender, high ESR, extranodal involvement, B-symptoms, intermediate stages, advanced stages were not significant. Conclusion: This is the first detailed QoL and fatigue analysis in HL patients covering all stages of the disease before, during, and after therapy. QoL domains are clearly impaired before the onset of chemotherapy, but improve over time substantially. Baseline QoL is affected in considerable degree by tumor- and patient-specific characteristics. Importantly, type and intensity of HL treatment have no relevant negative impact on long term QoL or fatigue. The strong impact of severe fatigue at baseline on overall survival is currently analyzed in more detail and results will be presented. Disclosures: No relevant conflicts of interest to declare.

The crystal arthropathies

2013 ◽  
Vol 6 (11) ◽  
pp. 681-687 ◽  
Author(s):  
Robert A Jones ◽  
Brian Quilty
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Inflammatory Arthritis ◽  
Term Treatment ◽  
Routine Practice ◽  
Treatment Goals ◽  
Crystal Arthropathies ◽  
Long Term Treatment

Unlike many other forms of inflammatory arthritis, the crystal arthropathies are routinely diagnosed and managed in primary care. Gout, in particular, is relatively commonplace and rates of other types of crystal-related arthritis are predicted to increase. These are, therefore, conditions that GPs and trainees will regularly encounter during routine practice. While the clinical features and pathophysiology of gout and pseudo-gout are well described, the long-term treatment goals and options of management are often less well understood, and opportunities to assess for associated co-morbidities can easily be missed. GPs can be central in optimising management by promptly and appropriately addressing acute symptoms, preventing recurrent attacks, minimising disability and work absences, reducing cardiovascular risk factors, improving general health and enhancing quality of life.

Modifiable Risk Factors for Neurocognitive and Psychosocial Problems After Hodgkin Lymphoma

Blood ◽  
2021 ◽  
Author(s):  
AnnaLynn M Williams ◽  
Sedigheh Mirzaei Salehabadi ◽  
Mengqi Xing ◽  
Nicholas Steve Phillips ◽  
Matthew Ehrhardt ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hodgkin Lymphoma ◽  
Chronic Health Conditions ◽  
Health Conditions ◽  
Cross Sectional ◽  
Chronic Health ◽  
Modifiable Factors ◽  
Task Efficiency

Long-term survivors of childhood Hodgkin lymphoma (HL) experience high burden of chronic health morbidities. Correlates of neurocognitive and psychosocial morbidity have not been well established. 1,760 survivors of HL (mean[SD] age 37.5[6.0] years, time since diagnosis 23.6[4.7] years, 52.1% female) and 3,180 siblings (age 33.2[8.5] years, 54.5% female) completed cross-sectional surveys assessing neurocognitive function, emotional distress, quality of life, social attainment, smoking, and physical activity. Treatment exposures were abstracted from medical records. Chronic health conditions were graded according to NCI CTCAE v4.3 (1=mild, 2=moderate, 3=severe/disabling, 4=life-threatening). Multivariable analyses, adjusted for age, sex, and race, estimated relative risk (RR) of impairment in survivors vs. siblings and, among survivors, risk of impairment associated with demographic, clinical, treatment factors and grade 2+ chronic health conditions. Compared with siblings, survivors had significant higher risk (p's&lt;0.05) of neurocognitive impairment (e.g. memory 8.1% vs. 5.7%), anxiety (7.0%%vs. 5.4%),depression (9.1% vs. 7%), unemployment (9.6% vs. 4.4%), and impaired physical/mental quality of life (e.g. physical function 11.2% vs. 3.0%). Smoking was associated with higher risk of impairment in task efficiency (RR=1.56[1.02-2.39]), emotional regulation (RR=1.84[1.35-2.49]), anxiety (RR=2.43[1.51-3.93]), and depression (RR=2.73[1.85-4.04]). Meeting CDC exercise guidelines was associated with lower risk of impairment in task efficiency (RR=0.70[0.52-0.95]), organization (RR=0.60[0.45-0.80]), depression (RR=0.66[0.48-0.92]), and multiple quality of life domains. Cardiovascular and neurologic conditions were associated with impairment in nearly all domains. Survivors of HL are at elevated risk for neurocognitive and psychosocial impairment, and risk is associated with modifiable factors that provide targets for interventions to improve long-term functional outcomes.

Health-Related Quality of Life in Patients With Hodgkin Lymphoma: A Longitudinal Analysis of the German Hodgkin Study Group

2020 ◽  
Vol 38 (25) ◽  
pp. 2839-2848 ◽  
Author(s):  
Stefanie Kreissl ◽  
Horst Müller ◽  
Helen Goergen ◽  
Julia Meissner ◽  
Max Topp ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hodgkin Lymphoma ◽  
Reference Values ◽  
Study Group ◽  
Life Questionnaire ◽  
Health Related Quality ◽  
German Hodgkin Study Group ◽  
Related Quality ◽  
Health Related

PURPOSE Many important details of health-related quality of life (HRQoL) after diagnosis and treatment of Hodgkin lymphoma (HL) are still unknown because large longitudinal studies of HRQoL are rare. Therefore, we analyzed a systematically assessed, comprehensive range of HRQoL domains in patients with HL of all stages from diagnosis up to 5 years of survivorship. PATIENTS AND METHODS We included patients with HL age 18-60 years at diagnosis from the German Hodgkin Study Group trials HD13, HD14, and HD15. We analyzed HRQoL using all functional and symptom scales of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 including deviations from reference values. We estimated the effect of different disease, patient, and treatment characteristics using multiple regression and repeated measures analysis and computed correlations of HRQoL scores. RESULTS We analyzed 4,215 patients with any HRQoL assessment within 5 years after treatment. Higher tumor burden at diagnosis was associated with impaired baseline scores in many HRQoL domains. During survivorship, cognitive, emotional, role, and social functioning and fatigue, dyspnea, sleep, and financial problems were severely and persistently affected. From year 2 on, mean deviations from reference values ranged between 12 and 29 points, with 10 points being a commonly used margin of clinical relevance. In all 3 trials, HRQoL domains 2 and 5 years after therapy were significantly influenced by baseline scores and age but not by randomized treatments. Fatigue was most closely correlated with other symptoms and scales. CONCLUSION Our results show a high and persistent amount of different HRQoL deficits in survivors of HL that are largely independent of the applied chemotherapies. Our analysis underscores the high, unmet medical need of these rather young survivors of HL regarding the psychosocial adverse effects of the cancer experience.

Characterization of Sepsis and Sepsis-Associated Encephalopathy

2017 ◽  
Vol 34 (11-12) ◽  
pp. 938-945 ◽  
Author(s):  
Qing Feng ◽  
Yu-Hang Ai ◽  
Hua Gong ◽  
Long Wu ◽  
Mei-Lin Ai ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Risk Factor ◽  
Diagnostic Criteria ◽  
Mortality Rates ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Long Term Prognosis

Background: Sepsis and sepsis-associated encephalopathy (SAE) are common intensive care unit (ICU) diseases; the morbidity and mortality are high. The present study analyzed the sensitivity of different diagnostic criteria of sepsis 1.0 and 3.0, epidemiological characteristics of sepsis and SAE, and explored its risk factors for death, short-term, and long-term prognosis. Methods: The retrospective study included patients in ICU from January 2015 to June 2016. After excluding 58 patients, 175 were assigned to either an SAE or a non-SAE group (patients with sepsis but no encephalopathy). The sensitivity of the diagnostic criteria was compared between sepsis 1.0 and 3.0, respectively. Between-group differences in baseline data, Acute Physiology and Chronic Health Evaluation II score (APACHE II score), Sequential Organ Failure Assessment score (SOFA score), etiological data, biochemical indicators, and 28-day and 180-day mortality rates were analyzed. Survival outcomes and long-term prognosis were observed, and risk factors for death were analyzed through 180-day follow-up. Results: The sensitivity did not differ significantly between the diagnostic criteria of sepsis 1.0 and 3.0 ( P = .286). The 42.3% incidence of SAE presented a significantly high APACHE II and SOFA scores as well as 28-day mortality and 180-day mortality (all P < .001). The incidence of death was 37.1%. The multivariate stepwise regression analysis demonstrated that the risk of death in SAE group was significantly higher than the non-SAE group ( P < .001). Sepsis-associated encephalopathy is a risk factor for sepsis-related death (relative risk [RR] = 2.868; 95% confidence interval: 1.730-4.754; P < .001). Although males showed a significantly high rate of 28-day and 180-day mortality ( P = .035 and .045), it was not an independent risk factor for sepsis-related death ( P = .072). The long-term prognosis of patients with sepsis was poor with decreased quality of life. No significant difference was observed in prognosis between the SAE and non-SAE groups ( P > .05). Conclusion: Both diagnostic criteria cause misdiagnosis, and the sensitivity did not differ significantly. The incidence of SAE was high, and 28-day and 180-day mortality rates were significantly higher than those without SAE. Sepsis-associated encephalopathy is a risk factor for poor outcome. The overall long-term prognosis of patients with sepsis was poor, and the quality of life decreased.

A literature review of the role of brachytherapy in the management of early-stage breast cancer

2019 ◽  
Vol 19 (3) ◽  
pp. 281-290
Author(s):  
Rebecca Thorpe ◽  
Heather Drury-Smith
Keyword(s):  
Quality Of Life ◽  
Overall Survival ◽  
Local Recurrence ◽  
Literature Review ◽  
Survival Rates ◽  
External Beam Radiation ◽  
Recurrence Rates ◽  
Overall Survival Rates

AbstractBackground:This review evaluates whether brachytherapy can be considered as an alternative to whole breast irradiation (WBI) using criteria such as local recurrence rates, overall survival rates and quality of life (QoL) factors. This is an important issue because of a decline in local recurrence rates, suggesting that some women at very low risk of recurrence may be incurring the negative long-term side effects of WBI without benefitting from a reduction in local recurrence and greater overall survival. As such, the purpose of this literature review is to evaluate whether brachytherapy is a credible alternative to external beam radiation with a particular focus on the impact it has on patient QoL.Methods:The search terms used were devised by using the Population Intervention Comparison Outcome framework, and a literature search was carried out using Boolean connectors and Medical Subject Headings in the PubMed database. The resultant articles were manually assessed for relevance and appraised using the Scottish Intercollegiate Guidelines Network tool. Additional papers were sourced from the citations of articles found using the search strategy. Government guidelines and regulations were also used following a manual search on the National Institute for Health and Care Excellence website. This process resulted in a total of 30 sources being included as part of the review.Results:Three types of brachytherapy were the foundation for the majority of the papers found: interstitial multi-catheter brachytherapy, intra-cavity brachytherapy and permanent seed implantation. The key themes that arose from the literature were that brachytherapy is equivalent to WBI both in terms of 5-year local recurrence rates and overall survival rates at 10–12 years. The findings showed that brachytherapy was superior to WBI for some QoL factors such as being less time-consuming and equal in terms of others such as breast cosmesis. The results did also show that brachytherapy does come with its own local toxicities that could impact upon QoL such as the poor breast cosmesis associated with some brachytherapy techniques.Conclusion:In conclusion, brachytherapy was deemed a safe or acceptable alternative to WBI, but there is a need for further research on the long-term local recurrence rates, survival rates and quality of life issues as the volume of evidence is still significantly smaller for brachytherapy than for WBI. Specifically, there needs to be further investigation as to which patients will benefit from being offered brachytherapy and the influence that factors such as co-morbidities, performance status and patient choice play in these decisions.

scholarly journals Quality of Life is Similar between Long-term Survivors of Indolent and Aggressive Non-Hodgkin Lymphoma

2016 ◽  
Vol 34 (6) ◽  
pp. 279-285 ◽  
Author(s):  
Anne W. Beaven ◽  
Greg Samsa ◽  
Sheryl Zimmerman ◽  
Sophia K. Smith
Keyword(s):  
Quality Of Life ◽  
Hodgkin Lymphoma ◽  
Non Hodgkin Lymphoma ◽  
Long Term Survivors

scholarly journals Quality of Life Among Long-Term Survivors of Non-Hodgkin Lymphoma: A Follow-Up Study

2013 ◽  
Vol 31 (2) ◽  
pp. 272-279 ◽  
Author(s):  
Sophia K. Smith ◽  
Deborah K. Mayer ◽  
Sheryl Zimmerman ◽  
Christianna S. Williams ◽  
Habtamu Benecha ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Hodgkin Lymphoma ◽  
Symptom Burden ◽  
Non Hodgkin Lymphoma ◽  
The Impact ◽  
Long Term Survivors ◽  
Over Time

Purpose Little is known about change in quality of life (QOL) among long-term cancer survivors. We examined change over time in QOL among long-term survivors of non-Hodgkin lymphoma and identified demographic, clinical, and psychosocial risk factors for poor outcomes. Methods Surveys were mailed to 682 lymphoma survivors who participated in a study 5 years earlier, when on average they were 10.4 years postdiagnosis. Standardized measures of QOL, perceptions of the impact of cancer, symptoms, medical history, and demographic variables were reported at both time points and examined using linear regression modeling to identify predictors of QOL over time. Results A total of 566 individuals participated (83% response rate) who were a mean of 15.3 years postdiagnosis; 52% were women, and 87% were white. One third of participants (32%) reported persistently high or improved QOL, yet a notable proportion (42%) reported persistently low or worsening QOL since the earlier survey. Participants who received only biologic systemic therapy reported improvement in physical health despite the passage of time. Older age, more comorbidity, and more or increasing negative and decreasing positive perceptions of cancer's impact were independent predictors of poor QOL. Lymphoma symptom burden, less social support, and having received a transplantation were related to negative perceptions of cancer's impact. Conclusion Moderate to severe symptom burden, limited social support, or having received a transplantation should alert the clinician to potential need for supportive services. Perceptions of cancer's impact are associated with QOL cross-sectionally and longitudinally; modifying these perceptions may thus provide a strategy for improving QOL.

Long-term efficacy of 90Y ibritumomab tiuxetan therapy in follicular non-Hodgkin lymphoma and health-related quality of life

2014 ◽  
Vol 93 (12) ◽  
pp. 1985-1992 ◽  
Author(s):  
Marcio Miguel Andrade-Campos ◽  
Anel E. Montes-Limón ◽  
Gloria Soro-Alcubierre ◽  
José María Grasa ◽  
Luis Lopez-Gómez ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hodgkin Lymphoma ◽  
Health Related Quality ◽  
Ibritumomab Tiuxetan ◽  
Term Efficacy ◽  
Non Hodgkin Lymphoma ◽  
Related Quality ◽  
Health Related

scholarly journals Health-related quality of life of COVID-19 survivors at 6 months after hospital discharge: a cohort study

2021 ◽  
Author(s):  
MeiXuan Lin ◽  
Liqun Huang ◽  
Danwen Zheng ◽  
Linjie Zhang ◽  
Bing Feng ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Cognitive Function ◽  
Health Related Quality ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related

Abstract Background: COVID-19 is a multi-systemic disease that is highly contagious and pathogenic. The long-term consequences of it are not yet clear, as is whether society and life can return to a healthy state. Long-term assessment of their health-related quality of life (HRQoL) is essential. This study aimed to investigate HRQoL and its risk factors in COVID-19 survivors at a follow-up of 6-month. Methods: A multicenter cross-sectional survey was conducted among 192 COVID-19 patients with confirmed age ≥ 18 years who were discharged from various hospitals in Wuhan from January to April 2020. The demographic characteristics, clinical characteristics, and laboratory results of the study subjects were obtained from the hospital's medical records. Survivors' HRQoL was assessed using the Short Form 36 (SF-36), cognition was assessed using the ascertain dementia eight-item informant questionnaire (AD8), and survivors' pulmonary function were examined. All participants in this study completed the survey and testing at Hubei Provincial Hospital of Chinese and Western Medicine. SF-36 scores were compared with the Chinese norm, and logistic regression and multivariate analysis were used to investigate the factors affecting HRQoL in COVID-19 survivors. Results: SF-36 showed significant differences in HRQoL between COVID-19 survivors and the general Chinese population ( P< 0.05).Multiple linear regression demonstrated that age was negatively correlated with physical functioning (PF), role-physical limitation (RP) and social functioning (SF) ( P <0.05). Bodily pain (BP), vitality (VT), SF and role-emotional limitation (RE) were negatively correlated with females ( P <0.05). Length from discharge to follow‐up was positively correlated with PF and RP ( P <0.05). Abnormal cognitive function was negatively correlated with PF, RP, general health (GH), VT, SF, RE and mental health (MH) ( P <0.05). Abnormal Carbon Monoxide Diffusing Capacity (DLCO%<80%) was significantly negatively correlated with PF and SF ( P <0.05).In addition, there was a significant negative correlation between Coronary heart disease and RP, GH, VT and RE ( P <0.05).Logistic regression analysis demonstrated that age(OR 1.032) and AD8 scores (OR 1.203)were risk factors associated with a low physical component summary (PCS) score. Length from discharge to follow‐up (OR 0.971) was the protective factor for PCS score. Abnormal cognitive function (OR 1.543) was a significant determinant associated with a mental component summary (MCS)<50 in COVID-19 patients. Conclusions: The HRQoL of COVID-19 survivors remains to be improved at six-month follow-up. Future studies should track HRQoL in older adults, women, patients with abnormal DLCO, and abnormal cognitive function for a long time and provide them with rehabilitation advice and guidance.

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