Better quality of life among 10–15 year survivors of Hodgkin’s lymphoma compared to 5–9 year survivors: A population-based study
Introduction
Hodgkin’s lymphoma is a relatively uncommon malignancy. In the Netherlands, the incidence is 1 in 50,000,1 with approximately 350 new cases annually. The disease affects men more often than women. Onset occurs most frequently between the ages of 20 and 35 years. Between 35 and 50 years it occurs less often, especially in females, but from the age of 50 onward there is again a rise in incidence with age. Hodgkin’s lymphoma is considered a curable disease although conditional 5-year survival is <90%.2 The use of appropriate staging techniques and treatment methods has resulted in high long-term survival rates. In the south of the Netherlands, 5-year relative survival is 82% and 10-year relative survival is 77% depending on the stage.3 If a person is alive 5 years after initial diagnosis, he is considered a ‘long-term survivor’ according to the guidelines of the American Cancer Society.4 In 2000 there were about 4450 Hodgkin’s lymphoma survivors in the Netherlands and this group is expected to increase to nearly 7000 survivors in 2010.1 This illustrates the rapid increase in the numbers of individuals who are either cured of their cancer or are living with it as a chronic disease.5
Hodgkin’s lymphoma survivors face very specific problems that have become more apparent as greater numbers of successfully treated patients have been followed for longer periods of time. They concern mainly chronic medical as well as psychosocial complications that can affect their quality of life (QoL). Patients can be treated with systemic therapy, radiotherapy or a combination of both. These interventions may result in severe infections and may cause thyroid, cardiovascular, pulmonary, digestive or gonadal dysfunction, hypothyroidism and secondary malignancy.6, 7 To date, a number of studies have evaluated the long-term effects of Hodgkin’s lymphoma and its treatment on QoL.8, 9, 10, 11, 12, 13, 14, 15, 16, 17 These studies indicate that the survivors more often have a decreased, self-reported health status, increased levels of generalised distress, fear of recurrence and other worries about their disease, and problems in the realms of intimacy and sexuality. Furthermore, the survivors may experience fatigue and loss of energy and late effects on skin and mucous membrane. Practical problems may also occur, including employment and insurance discrimination and difficulties with financial loans.9, 10, 11, 17, 18, 19 However, most of these studies were either based on a small number of survivors,9, 11 were primarily investigating fatigue17, 19 or included patients who were treated up to two decades ago.9, 11, 17
The aim of the present, cross-sectional study was to obtain insight into the QoL of long-term Hodgkin’s lymphoma survivors in a large population-based study. We compared the QoL of individuals who had survived the disease for 5–9 years with that of patients who had survived 10–15 years. We also studied the differences in QoL between Hodgkin’s lymphoma survivors and an age-matched normative sample from the general Dutch population. Finally, we assessed changes in work situations, and problems with insurance and loans.
Section snippets
Setting and participants
A population-based, cross-sectional survey was conducted at the Eindhoven Cancer Registry (ECR). The ECR records data on all patients newly diagnosed with cancer in the southern part of the Netherlands, an area with 2.3 million inhabitants, 18 hospital locations and two large radiotherapy institutes.3 The ECR was used to select all patients diagnosed with Hodgkin’s lymphoma between 1989 and 1998. Participants older than 75 years at diagnosis were excluded, as it was expected that they would
Results
Questionnaires were sent to 164 patients, 132 (80%) of whom returned completed forms (Fig. 1). No statistically significant differences in age at the time of survey, years since diagnosis, stage at diagnosis or initial treatment were found between respondents, non-respondents and patients with unverifiable addresses (Table 1). A number of patients were excluded from the final analyses because they exhibited disease progression (five new primary tumours, four metastasis and six recurrence),
Discussion
The aim of the present study was to describe the QoL for long-term Hodgkin’s lymphoma survivors 5–15 years after diagnosis, and to compare it to the general Dutch population. QoL was better among patients diagnosed 10–15 years ago compared to patients diagnosed 5–9 years ago. Patients diagnosed 5–9 years ago experienced lower general health, social functioning, mental health and vitality compared to an age-matched normative sample, while patients diagnosed 10–15 years earlier reported lower
Conflict of interest statement
None declared.
Acknowledgements
Interzol and ‘The Foundation for the promotion of Academic Training and Research in Health Care’ (SWOOG) financially supported this study. Floortje Mols also received a grant from the Beunke fund for lymphoma research.
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2013, Annals of OncologyCitation Excerpt :There were no significant changes in the mental component of QoL, and there were also no significant differences in the changes between patients who did or did not experience a new interim late effect. Prior studies on health-related QoL of HL survivors, using mostly the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30 or the SF-36, have shown that survivors, when compared with normal controls, have lower physical functioning [10, 12, 13, 19, 21, 22] and social functioning [10, 13, 22], while mental health functioning appears comparable between the two groups [10, 12, 13, 25]. Factors associated with diminished QoL have also been explored although the results have been inconsistent.
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2012, European Journal of CancerCitation Excerpt :This percentage is quite comparable to two small studies where problems were reported by 2% of hereditary non-polyposis colorectal cancer mutation carriers,5 and 6% of melanoma survivors.7 However, two other studies among Hodgkin and non-Hodgkin lymphoma survivors in the Netherlands showed much higher rates of problems with obtaining a home loan among those who actually tried (63% and 73%, respectively).17,18 Differences might be explained by a shift in bank rules and regulations over the past decades.
Type D (distressed) personality is associated with poor quality of life and mental health among 3080 cancer survivors
2012, Journal of Affective DisordersCitation Excerpt :Many of those survivors face continuing physical and mental problems due to cancer and its treatment. Most survivorship studies focus on the role of clinical variables to explain differences in quality of life (QoL) between patients (Mols et al., 2006, 2008; van de Poll-Franse et al., 2007). However, there is still a significant gap in our understanding of the determinants of QoL and mental health status outcomes; the role of individual differences is under exposed.