Can Hodgkin disease be the causa of permament fatigue?

PHodgkin’s disease is a lymphatic system neoplasm, which can be developed by both – children and adults. The median age at first diagnosis is about 30 years. Permanent fatigue which is recently reported by survivors more frequently, is becoming a serious problem during extensive care of the patient.

In the published paper in September 2016 in the online version of Lancet Oncology, German scientists presented the results of longitudinal observations concerning existence and prevalence of permanent fatigue of survivors which were made by German Hodgkin Study Group.

4981 people were selected from the patients who were taking part in clinical trials HD13 -881 people (early-stage favourable disease), HD14 – 1588 people (early-stage unfavourable disease), and HD15 – 1746 people (advanced-stage disease) and fulfilled the inclusive criteria which comprised: newly diagnosed, histologically proven Hodgkin’s lymphoma, an Eastern Cooperative Oncology Group (ECOG) performance status of 2 or lower, HIV negativity, and absence of comorbidity disallowing protocol treatment. Patients included to the study group were between 18 and 60 years old.

To the final analyze, data collected from 4215 patients who had been following-up for 5 years after the end of the treatment were used.

Every person from the study group was asked for filling out the quality-of-life questionnaire (QLQ-S) for several times: immediately after diagnosis (baseline), after two to four cycles of chemotherapy, immediately after end of treatment, and at predefined follow-up examinations up to 5 years after end of treatment.

According to the presented results, a significant part of the patients admitted to feeling fatigue at the baseline. Number of patients describing their fatigue level as very high increased according to the stage of disease – up to 48% of the people from study group HD15 stated that there are experiencing severe fatigue.

In the contrast to different fatigue levels at baseline, fatigue during treatment, as well as long-term fatigue (at 2 years and 5 years after the end of treatment), was very similar among patients with all different stages of Hodgkin’s disease.

Existence of fatigue at the baseline was an important predictor of its presence after the end of the therapy. Patients who described fatigue level as very high at the beginning of the treatment tended to remain feeling fatigue even 5 years after overcoming the disease. At the same time, patients with advanced-stage disease with moderate fatigue level at the baseline noted improvement of quality of their lives after ending treatment.

Despite of the differences in the stage of disease and intensity of the therapy, none significant difference between these three groups was found regarding number of patients, who had not have fatigue problems at the end of the treatment.

Results of this study have shown that feeling fatigue is quite common in the group of Hodgkin’s lymphoma survivors and the stage of disease at the moment of diagnosis is not very relevant when it comes to predicting the presence of long-term fatigue after the end of therapy.

Collected data may give the chance of creating new systems to help survivors understand and improve their current situations in the future.

Written by: Karolina Lewczuk, Magdalena Rejmak, Katarzyna Kubiak

1. Kreissl S., Mueller H., Goergen H., Mayer A., Brillant C., Behringer K., Halbsguth T.V., Hitz F., Soekler M., Shonukan O., Rueffer J.U., Flechtner H-H., Fuchs M., Diehl V., Engert A., Borchmann P.. on behalf of the German Hodgkin Study Group – Cancer-related fatigue in patients with and survivors of Hodgkin’s lymphoma: a longitudinal study of the German
Hodgkin Study Group. Lancet Oncol 2016 Published Online September 6, 2016

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