Medical Oncology

, Volume 18, Issue 1, pp 85–94 | Cite as

Health-related quality of life and its potential prognostic implications in patients with aggressive lymphoma

A nordic lymphoma group trial
  • M. Jerkeman
  • S. Kaasa
  • M. Hjermstad
  • S. Kvaløy
  • E. Cavallin-Ståhl
Original Article


This study was conducted to explore treatment and disease-related effects on health-related quality of life (HRQoL) in patients with aggressive lymphoma, to identify predictors for impaired long-term HRQoL, and to analyze the prognostic value of pretreatment HRQoL. Ninety-five patients with aggressive lymphoma, constituting a subset of a randomized multicenter trial comparing CHOP and MACOP-B, entered a HRQoL study, using the EORTC QLQ-C30 questionnaire. Patient scores were compared to scores from an age- and genderadjusted reference population sample, and evaluation of the prognostic value of pretreatment QoL scores in relation to clinical prognostic factors was performed. Before treatment, patients exhibited lower scores of global QoL, physical, role, and social functions, and more appetite loss, compared to the reference population. Role functioning improved compared to baseline, but remained depressed compared to the reference group more than 8 mo after end of treatment. By then, the patient group displayed no difference in other HRQoL variables compared to that of the reference population. No reliable predictor for impaired long-term HRQoL could be identified. In multivariate analysis, including the factors of the International Prognostic Index, pretreatment global QoL was an independent prognostic marker for overall survival. In conclusion, in this population with aggressive lymphoma and favorable prognostic features, HRQoL was not substantially affected during the first year after diagnosis. Pretreatment global QoL may constitute a significant prognostic factor, meriting further investigation in prospective studies.


Aggressive lymphoma health-related quality of life prognostic factors chemotherapy 


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  1. 1.
    Shipp MA et al. 1993 A predictive model for aggressive NHL. The International Non-Hodgkin’s Lymphoma Prognostic Factors Project. N Engl J Med 329:987–994.CrossRefGoogle Scholar
  2. 2.
    Wisløff F, Hjorth M., 1997 Health-related quality of life assessed before and during chemotherapy predicts for survival in multiple myeloma. Nordic Myeloma Study Group. Br J Haematol 97:29–37.PubMedCrossRefGoogle Scholar
  3. 3.
    Coates A, et al. 1992 Prognostic value of quality-of-life scores during chemotherapy for advanced breast cancer. Australian New Zealand Breast Cancer Trials Group. J Clin Oncol 10:1833–1838.PubMedGoogle Scholar
  4. 4.
    Coates A, et al. 1993 Prognostic value of quality of life scores in a trial of chemotherapy with or without interferon in patients with metastatic malignant melanoma. Eur J Cancer 29A:1731–1734.PubMedCrossRefGoogle Scholar
  5. 5.
    Dancey J, et al. 1997 Quality of life scores:an independent prognostic variable in a general population of cancer patients receiving chemotherapy. The National Cancer Institute of Canada Clinical Trials Group. Qual Life Res 6:151–158.PubMedCrossRefGoogle Scholar
  6. 6.
    Jerkeman M, et al. 1999 CHOP versus MACOP-B in aggressive lymphoma—a Nordic Lymphoma Group randomised trial. Ann Oncol 10:1079–1086.PubMedCrossRefGoogle Scholar
  7. 7.
    Aaronson NK 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 85:365–376.PubMedCrossRefGoogle Scholar
  8. 8.
    Ringdal GI, Ringdal K. 1993 Testing the EORTC Quality of Life Questionnaire on cancer patients with heterogeneous diagnoses. Qual Life Res 2:129–140.PubMedCrossRefGoogle Scholar
  9. 9.
    Fayers PM, Aaronson NK, Bjordal K, Sullivan M. 1995 EORTC QLQ-C30 Scoring Manual. Brussels:EORTC Study Group of Quality of Life.Google Scholar
  10. 10.
    Morris J, Doyle C. 1994 Quality of life questionnaires in cancer clinical trials: imputing missing values. Psycho-Oncology 3:215–222.CrossRefGoogle Scholar
  11. 11.
    Hjermstad MJ, Fayers PM, Bjordal K, Kaasa S. 1998 Health-related quality of life in the general Norwegian population assessed by the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire: the QLQ-C30 (+3). J Clin Oncol 16, 1188–1196.PubMedGoogle Scholar
  12. 12.
    Hjermstad MJ, Fayers PM, Bjordal K, Kaasa S. 1998 Using reference data on quality of life—the importance of adjusting for age and gender, exemplified by the EORTC QLQ-C30(+3). Eur J Cancer 34, 1381–1389.PubMedCrossRefGoogle Scholar
  13. 13.
    Osoba D, Rodrigues G, Myles J, Zee B, Pater J. 1998 Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 16, 139–144.PubMedGoogle Scholar
  14. 14.
    Sprangers M. 1996 Response-shift bias: a challenge to the assessment of patients’ quality of life in cancer clinical trials. Cancer Treat Rev 22(Suppl. A):55–62.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc 2001

Authors and Affiliations

  • M. Jerkeman
    • 3
  • S. Kaasa
    • 1
  • M. Hjermstad
    • 2
  • S. Kvaløy
    • 2
  • E. Cavallin-Ståhl
    • 3
  1. 1.Palliative Medicine Unit, Department of OncologyUniversity HospitalTrondheimNorway
  2. 2.Department of OncologyNorwegian Radium HospitalOsloNorway
  3. 3.Department of OncologyLund University HospitalLundSweden

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