Elsevier

European Journal of Cancer

Volume 42, Issue 16, November 2006, Pages 2794-2801
European Journal of Cancer

Better quality of life among 10–15 year survivors of Hodgkin’s lymphoma compared to 5–9 year survivors: A population-based study

https://doi.org/10.1016/j.ejca.2006.08.006Get rights and content

Abstract

This study describes the quality of life (QoL) of long-term Hodgkin’s lymphoma survivors and compares it to an age-matched normative sample. The population-based Eindhoven Cancer Registry was used to select all patients diagnosed with Hodgkin’s lymphoma from 1989 to 1998.

Eighty percent of survivors completed the SF-36 and the quality of life-cancer survivors questionnaire. QoL was better among patients diagnosed 10–15 years ago compared to patients diagnosed 5–9 years ago. The patients diagnosed 5–9 years ago experienced lower general health, social functioning, mental health and vitality compared to an age-matched normative sample, while the patients diagnosed 10–15 years earlier reported lower general health but better physical functioning. Most patients reported that their work situation did not change. Problems pertaining to the obtainment of health insurance, life insurance and mortgages were high. QoL among Hodgkin’s lymphoma survivors is lower compared to an age-matched normative sample. Survivors furthermore experience some (financial) problems in the years after diagnosis.

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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