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Quality of life amongst lymphoma survivors in a developing country

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Abstract

Purpose

The survival for patients with lymphoma has improved over the past decades with the introduction of novel agents. Quality of life of these survivors is now being studied with focus on minimising the late effects of chemotherapy and improving psychosocial support. This study aims to determine the prevalence of anxiety and depression of lymphoma survivors and to investigate the possible association between these disorders and quality of life.

Methods

Patients with previous diagnosis of lymphoma who remained in remission were recruited from a major hospital in Malaysia. Quality of life of these patients was measured using European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30). Anxiety and depression symptoms were assessed using Hospital Anxiety and Depression scale (HADS).

Results

A total of 156 patients participated in this study. Eighteen percent (18 %) of patients had symptoms of anxiety, and 10 % had symptoms of depression. Patients who had higher depression scores were older, of lower education level and had more than one comorbidity illness. Patients with anxiety were associated with lower overall quality of life (QOL) score, lower emotional and cognitive functioning and complained more of fatigue and insomnia (p < 0.05). Patients who had depression were associated with lower physical functioning and complained more of insomnia (p < 0.05).

Conclusion

It is important for the treating physicians to ensure follow-up of lymphoma survivors for any psychological disorders in order early counseling and support can be provided. This may improve patients’ quality of life.

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References

  1. Morton LM, Wang SS, Devesa SS, Hartge P, Weisenburger DD, Linet MS (2006) Lymphoma incidence patterns by WHO subtype in the United States, 1992-2001. Blood 107(1):265–276. doi:10.1182/blood-2005-06-2508

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. National Cancer Registry Report. Malaysia cancer statistics—data and figure. (2007). www.care.upm.edu.my/dokumen/13603_NCR2007.pdf.

  3. Al-Hamadani M, Habermann TM, Cerhan JR, Macon WR, Maurer MJ, Go RS (2015) Non-Hodgkin lymphoma subtype distribution, geodemographic patterns, and survival in the US: a longitudinal analysis of the National Cancer Data Base from 1998 to 2011. Am J Hematol 90(9):790–795. doi:10.1002/ajh.24086

    Article  PubMed  Google Scholar 

  4. United States cancer statistics: 1999-2012 incidence and mortality webbased report. (2015). U.S. Cancer Statistics Working Group. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute, Atlanta: U.S.

  5. De Angelis R, Sant M, Coleman MP, Francisci S, Baili P, Pierannunzio D, Trama A, Visser O, Brenner H, Ardanaz E, Bielska-Lasota M, Engholm G, Nennecke A, Siesling S, Berrino F, Capocaccia R (2014) Cancer survival in Europe 1999-2007 by country and age: results of EUROCARE—5-a population-based study. Lancet Oncol 15(1):23–34. doi:10.1016/s1470-2045(13)70546-1

    Article  PubMed  Google Scholar 

  6. Lim RB, Loy EY, Lim GH, Zheng H, Chow KY, Lim ST (2015) Gender and ethnic differences in incidence and survival of lymphoid neoplasm subtypes in an Asian population: secular trends of a population-based cancer registry from 1998 to 2012. Int J Cancer 137(11):2674–2687. doi:10.1002/ijc.29635

    Article  CAS  PubMed  Google Scholar 

  7. Baskar R, Lee KA, Yeo R, Yeoh KW (2012) Cancer and radiation therapy: current advances and future directions. Int J Med Sci 9(3):193–199. doi:10.7150/ijms.3635

    Article  PubMed  PubMed Central  Google Scholar 

  8. Dotan E, Aggarwal C, Smith MR (2010) Impact of rituximab (Rituxan) on the treatment of B-cell non-Hodgkin’s lymphoma. P & T: Peer-Rev J Formulary Manag 35(3):148–157

    Google Scholar 

  9. Yeoh KW, Mikhaeel NG (2011) Role of radiotherapy in modern treatment of Hodgkin’s lymphoma. Adv Hematol 2011:258797. doi:10.1155/2011/258797

    Article  PubMed  Google Scholar 

  10. Gan GG, Subramaniam R, Bee PC, Chin EF, Abdul-Halim H, Tai MC (2014) Impact of inadequate doses of rituximab in the treatment of diffuse large B cell lymphoma in Malaysian patients. Asian Pac J Cancer Prev: APJCP 15(4):1703–1706

    Article  PubMed  Google Scholar 

  11. Epelbaum R (2000) Non-Hodgkin’s lymphoma: long-term survivors and adverse effects. Ann Oncol: Off J Eur Soc Med Oncol/ESMO 11(Suppl 3):123–128

    Article  Google Scholar 

  12. Ng AK, LaCasce A, Travis LB (2011) Long-term complications of lymphoma and its treatment. J Clin Oncol Off J Am Soc Clin Oncol 29(14):1885–1892. doi:10.1200/jco.2010.32.8427

    Article  Google Scholar 

  13. Arden-Close E, Pacey A, Eiser C (2010) Health-related quality of life in survivors of lymphoma: a systematic review and methodological critique. Leuk Lymphoma 51(4):628–640. doi:10.3109/10428191003587263

    Article  PubMed  Google Scholar 

  14. Oerlemans S, Mols F, Nijziel MR, Lybeert M, van de Poll-Franse LV (2011) The impact of treatment, socio-demographic and clinical characteristics on health-related quality of life among Hodgkin’s and non-Hodgkin’s lymphoma survivors: a systematic review. Ann Hematol 90(9):993–1004. doi:10.1007/s00277-011-1274-4

    Article  PubMed  PubMed Central  Google Scholar 

  15. Oerlemans S, Mols F, Nijziel MR, Zijlstra WP, Coebergh JW, van de Poll-Franse LV (2014) The course of anxiety and depression for patients with Hodgkin’s lymphoma or diffuse large B cell lymphoma: a longitudinal study of the PROFILES registry. J Cancer Survivor: Res Pract 8(4):555–564. doi:10.1007/s11764-014-0367-1

    Article  Google Scholar 

  16. Clinton-McHarg T, Carey M, Sanson-Fisher R, Tzelepis F, Bryant J, Williamson A (2014) Anxiety and depression among haematological cancer patients attending treatment centres: prevalence and predictors. J Affect Disord 165:176–181. doi:10.1016/j.jad.2014.04.072

    Article  PubMed  Google Scholar 

  17. Linden W, Vodermaier A, Mackenzie R, Greig D (2012) Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age. J Affect Disord 141(2–3):343–351. doi:10.1016/j.jad.2012.03.025

    Article  PubMed  Google Scholar 

  18. Tan SM, Beck KR, Li H, Lim ECL, Krishna LKR (2014) Depression and anxiety in cancer patients in a tertiary general hospital in Singapore. Asian J Psychiatr 8:33–37. doi:10.1016/j.ajp.2013.10.002

    Article  PubMed  Google Scholar 

  19. Loge JH, Abrahamsen AF, Ekeberg O, Hannisdal E, Kaasa S (1997) Psychological distress after cancer cure: a survey of 459 Hodgkin’s disease survivors. Br J Cancer 76(6):791–796

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Lua PL, Wong SY, Neni WS (2011) Anxiety and depressive symptoms and health-related quality of life status among patients with cancer in Terengganu. Malays ASEAN J Psychiatry 12(1)

  21. Pamuk GE, Harmandar F, Ermantas N, Harmandar O, Turgut B, Demir M, Vural O (2008) EORTC QLQ-C30 assessment in Turkish patients with hematological malignancies: association with anxiety and depression. Ann Hematol 87(4):305–310. doi:10.1007/s00277-008-0445-4

    Article  PubMed  Google Scholar 

  22. Bee PC, Gan GG, Sangkar VJ, Haris AR, Chin E (2011) Quality of life after haematopoietic stem cell transplantation in a multiracial population. Med J Malays 66(5):451–455

    CAS  Google Scholar 

  23. Priscilla D, Hamidin A, Azhar MZ, Noorjan K, Salmiah MS, Bahariah K (2011) The socio-demographic and clinical factors associated with quality of life among patients with haematological cancer in a large government Hospital in Malaysia. Malays J Med Sci: MJMS 18(3):49–56

    PubMed  PubMed Central  Google Scholar 

  24. Cheson BD, Pfistner B, Juweid ME, Gascoyne RD, Specht L, Horning SJ, Coiffier B, Fisher RI, Hagenbeek A, Zucca E, Rosen ST, Stroobants S, Lister TA, Hoppe RT, Dreyling M, Tobinai K, Vose JM, Connors JM, Federico M, Diehl V (2007) Revised response criteria for malignant lymphoma. J Clin Oncol Off J Am Soc Clin Oncol 25(5):579–586. doi:10.1200/jco.2006.09.2403

    Article  Google Scholar 

  25. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC, et al. (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376

    Article  CAS  PubMed  Google Scholar 

  26. Fayers PM AN, Bjordal K, Groenvold M, Curran D, Bottomley A (2001) The EORTC QLQ-C30 scoring manual. European Organisation for Research and Treatment of Cancer. Brussels

  27. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370

    Article  CAS  PubMed  Google Scholar 

  28. Luckett T, Butow PN, King MT, Oguchi M, Heading G, Hackl NA, Rankin N, Price MA (2010) A review and recommendations for optimal outcome measures of anxiety, depression and general distress in studies evaluating psychosocial interventions for English-speaking adults with heterogeneous cancer diagnoses. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 18(10):1241–1262. doi:10.1007/s00520-010-0932-8

    Article  Google Scholar 

  29. Smith AB, Selby PJ, Velikova G, Stark D, Wright EP, Gould A, Cull A (2002) Factor analysis of the Hospital Anxiety and Depression Scale from a large cancer population. Psychol Psychother 75(Pt 2):165–176

    Article  PubMed  Google Scholar 

  30. Ziegler L, Hill K, Neilly L, Bennett MI, Higginson IJ, Murray SA, Stark D (2011) Identifying psychological distress at key stages of the cancer illness trajectory: a systematic review of validated self-report measures. J Pain Symptom Manag 41(3):619–636. doi:10.1016/j.jpainsymman.2010.06.024

    Article  Google Scholar 

  31. Tabachnick BG, Fidell LS (2006) Using multivariate statistics (5th Edition). Allyn & Bacon, Inc.,

  32. Calaminus G, Dorffel W, Baust K, Teske C, Riepenhausen M, Bramswig J, Flechtner HH, Singer S, Hinz A, Schellong G (2014) Quality of life in long-term survivors following treatment for Hodgkin’s disease during childhood and adolescence in the German multicentre studies between 1978 and 2002. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 22(6):1519–1529. doi:10.1007/s00520-013-2114-y

    Article  Google Scholar 

  33. Heutte N, Flechtner HH, Mounier N, Mellink WA, Meerwaldt JH, Eghbali H, van’t Veer MB, Noordijk EM, Kluin-Nelemans JC, Lampka E, Thomas J, Lugtenburg PJ, Viterbo L, Carde P, Hagenbeek A, van der Maazen RW, Smit WG, Brice P, van Marwijk KM, Baars JW, Poortmans P, Tirelli U, Leeksma OC, Tomsic R, Feugier P, Salles G, Gabarre J, Kersten MJ, Van Den Neste E, Creemers GJ, Gaillard I, Meijnders P, Tertian G, Reman O, Muller HP, Troncy J, Blanc M, Schroyens W, Voogt PJ, Wijermans P, Rieux C, Ferme C, Henry-Amar M (2009) Quality of life after successful treatment of early-stage Hodgkin’s lymphoma: 10-year follow-up of the EORTC-GELA H8 randomised controlled trial. Lancet Oncol 10(12):1160–1170. doi:10.1016/s1470-2045(09)70258-x

    Article  PubMed  Google Scholar 

  34. Johnsen AT, Tholstrup D, Petersen MA, Pedersen L, Groenvold M (2009) Health related quality of life in a nationally representative sample of haematological patients. Eur J Haematol 83(2):139–148. doi:10.1111/j.1600-0609.2009.01250.x

    Article  PubMed  PubMed Central  Google Scholar 

  35. Jensen RE, Arora NK, Bellizzi KM, Rowland JH, Hamilton AS, Aziz NM, Potosky AL (2013) Health-related quality of life among survivors of aggressive non-Hodgkin lymphoma. Cancer 119(3):672–680. doi:10.1002/cncr.27781

    Article  PubMed  Google Scholar 

  36. Priscilla D, Hamidin A, Azhar MZ, Noorjan KO, Salmiah MS, Bahariah K (2011) Assessment of depression and anxiety in haematological cancer patients and their relationship with quality of life. East Asian Arch Psychiatry: Off J Hong Kong Coll Psychiatrists = Dong Ya jing shen ke xue zhi: Xianggang jing shen ke yi xue yuan qi kan 21(3):108–114

    Google Scholar 

  37. Institute for Public Health (IPH) (2011). National health and morbidity survey 2011 (NHMS 2011). Vol II: Non-communicable diseases

  38. Pulgar A, Alcala A, Reyes Del Paso GA (2015) Psychosocial predictors of quality of life in hematological cancer. Behav Med (Washington, DC) 41(1):1–8. doi:10.1080/08964289.2013.833083

    Article  Google Scholar 

  39. Santos FR, Kozasa EH, Chauffaille Mde L, Colleoni GW, Leite JR (2006) Psychosocial adaptation and quality of life among Brazilian patients with different hematological malignancies. J Psychosom Res 60(5):505–511. doi:10.1016/j.jpsychores.2005.08.017

    Article  PubMed  Google Scholar 

  40. Skarstein J, Aass N, Fossa SD, Skovlund E, Dahl AA (2000) Anxiety and depression in cancer patients: relation between the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire. J Psychosom Res 49(1):27–34

    Article  CAS  PubMed  Google Scholar 

  41. Nikbakhsh N, Moudi S, Abbasian S, Khafri S (2014) Prevalence of depression and anxiety among cancer patients. Caspian J Int Med 5(3):167–170

    Google Scholar 

  42. Martin MY, Fouad MN, Oster RA, Schrag D, Urmie J, Sanders S, Pisu M (2014) What do cancer patients worry about when making decisions about treatment? Variation across racial/ethnic groups. Support Care Cancer: Off J Multinatl Assoc Support Care Cancer 22(1):233–244. doi:10.1007/s00520-013-1958-5

    Article  Google Scholar 

  43. Kwok W, Bhuvanakrishna T (2014) The relationship between ethnicity and the pain experience of cancer patients: a systematic review. Indian J Palliat Care 20(3):194–200. doi:10.4103/0973-1075.138391

    Article  PubMed  PubMed Central  Google Scholar 

  44. Lord K, Ibrahim K, Kumar S, Mitchell AJ, Rudd N, Symonds RP (2013) Are depressive symptoms more common among British South Asian patients compared with British White patients with cancer? A cross-sectional survey. BMJ open 3 (6). doi:10.1136/bmjopen-2013-002650

  45. Luckett T, Goldstein D, Butow PN, Gebski V, Aldridge LJ, McGrane J, Ng W, King MT (2011) Psychological morbidity and quality of life of ethnic minority patients with cancer: a systematic review and meta-analysis. Lancet Oncol 12(13):1240–1248. doi:10.1016/s1470-2045(11)70212-1

    Article  PubMed  Google Scholar 

  46. Gil-Fernandez J, Ramos C, Tamayo T, Tomas F, Figuera A, Arranz R, Martinez-Chamorro C, Fernandez-Ranada M (2003) Quality of life and psychological well-being in Spanish long-term survivors of Hodgkin’s disease: results of a controlled pilot study. Ann Hematol 82(1):14–18. doi:10.1007/s00277-002-0582-0

    CAS  PubMed  Google Scholar 

  47. Ness KK, Gurney JG, Zeltzer LK, Leisenring W, Mulrooney DA, Nathan PC, Robison LL, Mertens AC (2008) The impact of limitations in physical, executive, and emotional function on health-related quality of life among adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Arch Phys Med Rehabil 89(1):128–136. doi:10.1016/j.apmr.2007.08.123

    Article  PubMed  Google Scholar 

  48. Zebrack B, Burg MA, Vaitones V (2012) Distress screening: an opportunity for enhancing quality cancer care and promoting the oncology social work profession. J Psychosoc Oncol 30(6):615–624. doi:10.1080/07347332.2012.721485

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank Professor Dr. Md Mizanur Rahman from Univeristi Malaysia Sarawak for his invaluable opinion and assistance in statistical analysis.

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Authors and Affiliations

  1. Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia

    Diana L. C. Ng

  2. Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

    Y. C. Leong & Gin Gin Gan

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  1. Diana L. C. Ng
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  3. Gin Gin Gan
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Correspondence to Gin Gin Gan.

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Conflict of interest

This study is funded by University Malaya High Impact Research Grant (UM HIR grant E-000008-20001). The corresponding author is an employee of the University of Malaya. Otherwise, all authors had no conflict of interests. The authors have full control of the primary data and agree for the data to be reviewed if necessary.

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Ng, D.L.C., Leong, Y.C. & Gan, G.G. Quality of life amongst lymphoma survivors in a developing country. Support Care Cancer 24, 5015–5023 (2016). https://doi.org/10.1007/s00520-016-3364-2

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