Fatigue- and health-related quality-of-life in anemic patients with lymphoma or multiple myeloma
The purpose of this study was to describe perceptions of fatigue in anemic patients with lymphoma or multiple myeloma (MM).
This is an observational multicenter study in a prospective cohort of lymphoma and MM patients with hemoglobin ≤ 11 g/dl managed under clinical practice. Fatigue was assessed at baseline and after 3 months using the PERFORM questionnaire, the Functional Assessment of Cancer Therapy-Fatigue, the linear analogue self-assessment, and visual analogue scale (VAS) scales.
Two hundred and fifty patients (125 with lymphoma, 125 with MM) were included. Only 59.2 and 56.0% of patients received treatment for anemia, respectively. After 3 months, the hemoglobin levels increased significantly compared to baseline from 10.0 ± 1.2 to 11.5 ± 1.8 in the lymphoma group and from 9.9 ± 0.9 to 10.9 ± 1.5 g/dl, in the MM group (P < 0.001, both comparisons). At baseline, 87.2 and 84.8% of patients had fatigue (median intensity (VAS) 60 and 50). The overall PERFORM score decreased from 35.2 ± 15.2 to 32.0 ± 14.6 (P = 0.048), without differences between groups. No statistically significant changes were observed in the other scales. After multivariable adjustment, the only common independent factor associated to improvements in fatigue and health-related quality-of-life (HRQoL) was an increase in hemoglobin levels. The administration of curative intention treatment was also associated with HRQoL improvements. The psychometric properties of the PERFORM questionnaire in MM patients were good (Cronbach’s alpha 0.87–0.98; intraclass correlation coefficients 0.84–0.89; effect sizes 0.59–0.96).
Almost all patients with lymphoma or MM diagnosed with anemia suffered from fatigue of moderate to severe intensity. Despite similar anemia supportive treatment, better correction of fatigue scores was observed in lymphoma patients after 3 months. Increases in hemoglobin were significantly associated to improvements in fatigue and HRQoL.
KeywordsFatigue Anemia Lymphoma Multiple myeloma Quality-of-life Questionnaire
Writing assistance was supported by Amgen S.A. and provided by Dr. Neus Valveny from Trial Form Support, who wrote the first draft. The authors wish to acknowledge Ariadna Lloansí (Amgen S.A.) for the critical review of the manuscript and Amgen S.A. for financial support of this study. The conclusions, interpretations, and opinions expressed herein are those of the authors.
PERFORM V Study Group: Dr. Abelardo Bárez Garcia, Hospital Nuestra Señora de Sonsoles, Ávila, Spain; Dr. Antonio Salar, Hospital del Mar, Barcelona, Spain; Dra. Asunción Mora Casado, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain; Dra. Carme Talarn Forcadell, Hospital Universitari Joan XXIII, Tarragona, Spain; Dra. Cristina Encinas Rodriguez, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Dra. Emma Lopez Abadia, Hospital General Universitario de Elche, Elche, Spain; Dr. Fernando Escalante Barrigon, Hospital Universitario de León, León, Spain; Dra. Francisca Hernández, Hospital Universitario San Cecilio, Granada, Spain; Dra. Francisca Marín Jimenez, Hospital General Universitario de Elche, Elche, Spain; Dr. Javier De La Rubia, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Dr. Joan Bargay, Hospital Son Llàtzer, Palma de Mallorca, Spain; Dr. Juan José Lahuerta, Hospital Universitario Doce de Octubre, Madrid, Spain; Dr. Juan-Nicolas Rodriguez Rodriguez, Hospital Juan Ramón Jimenez, Huelva, Spain; Dra. Asunción Echeveste Gutierrez, Hospital Universitario Donostia, San Sebastián, Spain; Dra. María Victoria Moreno Romero, Hospital Juan Ramón Jimenez, Huelva, Spain; Dra. Mercedes Gironella, Hospital Universitari Vall D’Hebron, Barcelona, Spain; Dr. Miguel Hernández, Hospital Clínico Universitario de Canarias, San Cristóbal de La Laguna, Spain; Dra. Pilar Lopez Garrido, Hospital Universitario Virgen de Las Nieves, Granada, Spain; Dra. Pilar Rabasa, Hospital San Pedro y San Millán, Logroño, Spain; Dra. Reyes Arranz Sáez, Hospital Universitario La Princesa, Madrid, Spain; Dr. Secundino Ferrer, Hospital Universitario Doctor Peset, Valencia, Spain; Dra. Sonia Piernas, Corporació Sanitària Parc Taulí, Sabadell, Spain; Dr. Valentín Garcia, Hospital Universitario Ramón y Cajal, Madrid, Spain; Dra. Verónica Roldan, Hospital San Pedro y San Millan, Logroño, Spain.
All authors designed the study, coordinated the group, supervised clinical data collection, and reviewed the analysis and the manuscript. All the authors approved the final version of the manuscript.
Compliance with ethical standards
The study was approved by the Ethics Committee of the Hospital Clínic de Barcelona and has been performed in accordance with the Declaration of Helsinki. Informed consent was obtained from all study participants.
Conflict of interest
Dr. Ramos reports personal fees from AMGEN during the conduct of the study and grants, personal fees, and others from CELGENE; personal fees and other from NOVARTIS; personal fees from AMGEN; personal fees from GLAXO SMITH KLINE; personal fees from PFIZER; and personal fees and other from JANSSEN, outside the submitted work. The other authors have stated that they have no conflicts of interest.
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