Persistent and debilitating fatigue is a common problem for survivors of Hodgkin lymphoma, regardless of their disease stage or type of treatment, researchers in Germany reported.
The study, “Cancer-related fatigue in patients with and survivors of Hodgkin’s lymphoma: a longitudinal study of the German Hodgkin Study Group,” published in the journal Lancet Oncology, also found that feelings of “cancer-related” fatigue can begin as early as diagnosis, and be of lasting intensity for years.
“This finding is of special interest in patients with Hodgkin lymphoma because the disease has become a curable cancer for most patients,” Stephanie Kreissl, MD, the study’s lead author, and a member of the department of internal medicine at the University Hospital of Cologne, said in a press release, adding that the median age for people at first diagnosis is about 30.
Kreissl and her colleagues reviewed data from 4,215 patients with validated fatigue, collected at diagnosis and continuing for five years post-treatment. Patients were participants in three clinical trials overseen by the German Hodgkin Lymphoma Study Group: the HD13 trial (ISRCTN63474366) in those with early stage, favorable disease; the HD14 trial (ISRCTN04761296) in people with early stage but at-risk, or unfavorable, disease; and the HD15 (ISRCTN32443041) study in advanced-stage Hodgkin’s lymphoma (HL) patients.
All patients in these trials were treated with chemotherapy or a combination of chemotherapy and radiotherapy.
The researchers measured levels of fatigue based on the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire. They found that individuals with advanced-stage Hodgkin’s lymphoma reported higher fatigue scores at baseline (49) than those with early stage unfavorable (39.8) or favorable disease (30.8).
The number of patients with severe fatigue scores also was higher in those with advanced cancer than in those with cancers detected earlier.
After treatment, fatigue scores remained high in patients with more advanced disease (30.7 at year two, and 28.2 at year five), but also stayed elevated in others. Those with early but at-risk HL had scores of 28.8 and 27.1 at years two and five, respectively, while those not seen to be at risk had fatigue scores of 28.5 and 30.8.
Both baseline fatigue and age correlated with longer term fatigue, findings showed, and fatigue reports increased across all disease levels after patients started systemic chemotherapy. And while disease stage greatly influenced baseline fatigue, it likely did not strongly influence fatigue levels over time, possibly because “all the different treatment intensities used in our trials induced very severe fatigue symptoms,” the researchers said.
“It is important to note that persistent severe fatigue is a disabling disease, and has a major impact on patients’ lives,” they said. “These findings support the importance of baseline fatigue as a precursor of long-term fatigue.”
An individual’s sex was not related to fatigue levels, but the research team noted that findings may be limited by a lack of information on other diseases patients may have had, such as depression, anxiety, and sleep disorders, and by the increasing number of missing variables in the follow-up period.
“Cancer-related fatigue is a distinct diagnosis and a potentially disabling disease that has a course different from that of the coexisting diagnosis of Hodgkin lymphoma; successful treatment of the malignant lymphoma does not prevent the development of severe persistent fatigue,” the scientists concluded.
Authors in an accompanying editorial joined the researchers in calling for further research into fatigue in cancer patients.