Fast track — ArticlesQuality of life after successful treatment of early-stage Hodgkin's lymphoma: 10-year follow-up of the EORTC–GELA H8 randomised controlled trial
Introduction
Assessing the quality of life of patients with Hodgkin's lymphoma received little attention before the 1990s, probably because of the low incidence of the disease and its high probability of cure. Over the past two decades there has been increasing interest in late treatment-related effects, but almost all studies focusing on health-related quality of life (HRQoL) in adults with Hodgkin's lymphoma have used a cross-sectional approach, even in long-term survivors.1 To study the course of psychosocial consequences over time from diagnosis and treatment, most studies used population-based registry and hospital-based cohorts that included subgroups of patients with various follow-up periods. However, in such cohorts, medical histories including detailed treatment data are difficult to analyse. By contrast, longitudinal studies closely connected to clinical trials are able to provide the necessary bases for adequate analysis, particularly with regard to clinically relevant subgroups of patients.2
In 1993, the European Organisation for Research and Treatment of Cancer (EORTC) Lymphoma Group and the Groupe d'Études des Lymphomes de l'Adulte (GELA) initiated a randomised, non-blinded trial in patients with early-stage Hodgkin's lymphoma (the H8 trial).3 Here we report the results of the accompanying longitudinal prospective survey of HRQoL and fatigue in patients in complete remission. The objectives of this study were to analyse the relations between treatment, HRQoL, and fatigue, and to identify factors that predict persistent fatigue.
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Patients
Patients with previously untreated clinical stage I or II supradiaphragmatic Hodgkin's lymphoma were eligible for the trial.3 After stratification by prognostic factors (figure 1), patients in the very favourable group were treated with mantle-field radiotherapy. Those in the favourable group (H8-F) were randomly assigned to either subtotal nodal radiotherapy (STNI) or three cycles of mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (MOPP-ABV) and
Results
Of the 1577 patients included in the EORTC-GELA H8 trial by 91 hospitals, 1407 successfully responded to treatment, of whom 1014 participated in the HRQoL survey, contributing 4877 assessments. From these, 2211 were excluded: 219 because they were done before the end of treatment, 90 because they were done after a relapse had occurred (79 patients), and 1902 (449 patients) because they were classed as doublets within time periods. For these 449 patients with two or more HRQoL assessments in a
Discussion
We report the results of a longitudinal prospective survey on HRQoL in a large cohort of patients with Hodgkin's lymphoma who were included in a European clinical trial. Key findings include a significant improvement in most HRQoL domains within 18 months of the end of treatment, except for cognitive functioning and reduced motivation (table 3), suggesting that neither the treatment nor the disease affect these two dimensions. By contrast, very few (<10%) patients show HRQoL impairment. Scores
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