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Health-related quality of life and persistent symptoms in relation to (R-)CHOP14, (R-)CHOP21, and other therapies among patients with diffuse large B-cell lymphoma: results of the population-based PHAROS-registry

Abstract

The increasing number of longer-living patients with diffuse large B-cell lymphoma (DLBCL) and serious side effects of treatment urged us to study the health-related quality of life (HRQoL) and persistent (treatment-related) symptoms in unselected patients after different treatment modalities and compare HRQoL of patients with a normative population. The population-based Eindhoven Cancer Registry was used to select all patients diagnosed with DLBCL from 2004 to 2010. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) was completed twice, with a 1-year interval. Detailed data on treatment were extracted from the Population-based HAematological Registry for Observational Studies. Two hundred fifty-six patients responded (84 %, T1). Compared to patients treated with rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone every 21 days ((R-)CHOP21), those who underwent (R-)CHOP14 more often reported tingling in the hands and feet (27 vs 42 %, p = 0.02) and fatigue (35 vs 46 %, p = 0.03) and reported a lower global health status/HRQoL. Mean HRQoL was statistically and clinically relevantly lower among DLBCL patients compared to a normative population (p < 0.01). Persistent tingling in hands/feet was reported more often by older patients and patients treated with (R-)CHOP14 independently of the other characteristics. Furthermore, patients who reported symptoms exhibited significantly lower HRQoL compared to patients without symptoms/worries. Patients treated with (R-)CHOP14 reported more neuropathic symptoms, more fatigue, and a lower HRQoL than patients treated with (R-)CHOP21. Alertness for persistent symptoms that occur during and after treatment of DLBCL patients is needed and may help to avoid lasting negative influence on their HRQoL.

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Acknowledgement

We thank all patients and their doctors for their participation in the study. Special thanks goes to Dr. M. van Bommel for the independent advice and answering questions of patients invited to participate. Specialists in the following hospitals provided cooperation: Catharina-hospital, Eindhoven; Jeroen Bosch hospital, ‘s Hertogenbosch; Maxima Medical Center, Eindhoven and Veldhoven; Sint Anna hospital, Geldrop; St. Elisabeth hospital, Tilburg; Twee Steden hospital, Tilburg; VieCurie hospital, Venlo and Venray, and Hospital Bernhoven, Oss.

Funding

This study was financially supported by the Jonker-Driessen Foundation and ZonMW: the Netherlands organization for health research and development, and through PHAROS: Population-based HAematological Registry for Observational Studies (#80-82500-98-01007). Dr. Floortje Mols is supported by a VENI grant (#451-10-041) from the Netherlands Organization for Scientific Research (The Hague, The Netherlands), Dr. Lonneke van de Poll-Franse is supported by a Cancer Research Award from the Dutch Cancer Society (#UVT-2009-4349). These funding agencies had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report or in the decision to submit the paper for publication.

Conflict of interest

The authors declare that they have no conflict of interest.

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Correspondence to Simone Oerlemans.

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Authorship and disclosures

All authors contributed to the conception and design of this paper; SO, DEI, and LVP wrote the paper, all other authors revised the paper critically for important intellectual content; SO, FM, and MRN recruited the patients; DEI, EGB, JWC, and PH collected the clinical data; SO and EGB performed the statistical analysis; LVP was the principal investigator and takes primary responsibility for the paper.

This manuscript is not being considered for publication elsewhere, and the findings of this manuscript have not been previously published.

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Oerlemans, S., Issa, D.E., van den Broek, E.C. et al. Health-related quality of life and persistent symptoms in relation to (R-)CHOP14, (R-)CHOP21, and other therapies among patients with diffuse large B-cell lymphoma: results of the population-based PHAROS-registry. Ann Hematol 93, 1705–1715 (2014). https://doi.org/10.1007/s00277-014-2099-8

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  • DOI: https://doi.org/10.1007/s00277-014-2099-8

Keywords

  • Quality of life
  • Non-Hodgkin lymphoma
  • Diffuse large B-cell lymphoma
  • Cancer survivors
  • Population-based
  • Treatment
  • PHAROS
  • PROFILES