Negative illness perceptions are related to more fatigue among haematological cancer survivors: a PROFILES study

Figures & data

Table 1. Patient characteristics in frequencies and percentages or means and standard deviations.

		Subgroups of haematological cancer survivors
	Total group (N = 993)	HL (N = 164)	NHL (N = 655)	CLL (N = 174)	p Value^a
Sociodemograpgics
Age at diagnosis (SD)	56.3 (14.7)	41.6 (15.4)	58.4 (13.1)	62.6 (10.1)	<.01*^a,b,c
Gender
Male	608 (61.2)	89 (54.3)	403 (61.5)	116 (66.7)	.06
Educational level
Lower	142 (14.7)	13 (8.0)	99 (15.6)	30 (17.6)	.01*
Secondary	586 (60.5)	99 (60.7)	387 (60.8)	100 (58.8)
Higher	241 (24.9)	51 (31.3)	150 (23.6)	40 (23.5)
Marital status
Married/living together	772 (79.2)	122 (74.8)	513 (80.0)	137 (80.1)	.33
Divorced/widowed/never married	203 (20.8)	41 (25.2)	128 (20.0)	34 (19.9)
Employment status
Not employed	648 (69.8)	85 (56.7)	447 (73.0)	136 (81.9)	<.01*
Employed	280 (30.2)	65 (43.3)	165 (27.0)	30 (18.1)
Clinical factors
Years since diagnosis (SD)	4.4 (2.7)	4.9 (2.9)	4.3 (2.7)	4.3 (2.6)	.03*^a
Stage at diagnosis
I	224 (29.4)	30 (18.4)	194 (32.4)	NA	<.01*
II	202 (26.5)	83 (50.9)	119 (19.9)
III	142 (18.6)	33 (20.2)	109 (18.2)
IV	194 (25.5)	17 (10.4)	177 (29.5)
Treatment
Systemic therapy	674 (67.9)	159 (97.0)	472 (72.1)	43 (24.7)	<.01*
Radiotherapy	295 (29.7)	98 (59.8)	190 (29.0)	7 (4.0)	<.01*
No therapy	210 (21.1)	1 (0.6)	85 (13.0)	124 (71.3)	<.01*
BMI (SD)	26.3 (4.3)	25.9 (4.2)	26.5 (4.4)	25.9 (4.0)	.12
Comorbidity
None	355 (36.6)	83 (50.9)	224 (35.2)	48 (28.2)	<.01*
1	285 (29.4)	46 (28.2)	195 (30.7)	44 (25.9)
≥2	329 (34.0)	34 (20.9)	217 (34.1)	78 (45.9)

CLL: chronic lymphocytic leukaemia; HL: Hodgkin lymphoma; NA: not available; NHL: Non-Hodgkin lymphoma; SD: standard deviation.

*p < 0.05. Post-hoc tests were conducted for continuous variables.

^a Significant difference (p < 0.05) between HL and NHL patients;

^b Significant difference (p < 0.05) between HL and CLL patients;

^c Significant difference (p < 0.05) between NHL and CLL patients.

Table 2. Differences in fatigue, illness perceptions and symptoms of depression and anxiety scores according to haematological cancer group.

		Subgroups of haematological cancer survivors
	Total (n = 965)	HL (n = 163)	NHL (n = 636)	CLL (n = 166)	p Value^a
Fatigue
FAS total	21.5 (7.7)	21.2 (7.6)	21.8 (7.8)	20.8 (7.5)	.25
Substantial fatigue	412 (42.7)	65 (39.9)	287 (45.1)	60 (36.1)	.08
Illness perceptions
Consequences	4.2 (2.5)	4.4 (2.5)	4.3 (2.6)	3.7 (2.3)	.02*^b,c
Timeline	6.1 (3.6)	3.9 (3.0)	5.9 (3.6)	8.8 (2.3)	<.01*^a,b,c
Personal control	6.1 (3.2)	5.7 (3.2)	6.2 (3.2)	6.4 (3.3)	.20
Treatment control	3.2 (2.5)	2.3 (1.7)	3.2 (2.5)	4.3 (3.1)	<.01*^a,b,c
Identity	3.7 (2.6)	3.9 (2.6)	3.8 (2.7)	3.2 (2.4)	.01*^b^,^c
Concern	4.1 (2.7)	4.0 (2.7)	4.2 (2.7)	4.0 (2.5)	.78
Coherence	4.2 (2.9)	4.0 (2.8)	4.3 (3.0)	4.2 (3.0)	.57
Emotional representation	3.7 (2.6)	4.0 (2.7)	3.8 (2.6)	3.3 (2.5)	.04*^b
Psychological variables
Symptoms of depression	4.2 (3.9)	3.7 (3.9)	4.4 (3.9)	4.1 (3.8)	.09
Symptoms of anxiety	4.5 (3.9)	4.7 (4.3)	4.6 (3.8)	4.2 (3.7)	.49

Scores are presented in mean scores (standard deviation). Substantial fatigue (>21 FAS) in number and percentages. Mean scores of the three haematological cancers are compared by ANOVA- and post-hoc test. CLL: chronic lymphocytic leukaemia; HL: Hodgkin lymphoma; NHL: non-Hodgkin lymphoma.

^a Significant difference (p < .05) between HL and NHL patients;

^b Significant difference (p < .05) between HL and CLL patients;

^c Significant difference (p < .05) between NHL and CLL patients.

Figure 1. Means scores on illness perceptions stratified by those with (>21 FAS) and without (≤21 FAS) substantial fatigue. Illness perception scores (range 0–10) for those with (>21 FAS) and without substantial fatigue. *p < .05 in model 2 of the hierarchical multivariable logistic regression analyses. ^§Clinically important difference, if the difference is ≥ 0.5 standard deviation [25].

Table 3. Summary of hierarchical multivariable logistic regression analyses on associates of fatigue for the total group and each haematological cancer group.

	Total group		HL (N = 132)		NHL (N = 501)		CLL (N = 128)
	Model 1	Model 2	Model 1	Model 2	Model 1	Model 2	Model 1	Model 2
	OR (95%CI)	OR (95%CI)	OR (95%CI)	OR (95%CI)	OR (95%CI)	OR (95%CI)	OR (95%CI)	OR (95%CI)
Illness perceptions
Consequences	1.27 (1.13–1.42)*	1.20 (1.06–1.37)*	1.80 (1.19–2.72)*	2.59 (1.19–5.64)*	1.23 (1.08–1.40)*	1.17 (1.01–1.34)*	1.56 (1.08–2.24)*	1.39 (0.86–2.24)
Timeline	0.99 (0.92–1.07)	0.99 (0.91–1.07)	0.92 (0.72–1.17)	0.76 (0.51–1.13)	0.99 (0.91–1.07)	0.98 (0.89–1.07)	0.94 (0.73–1.21)	1.03 (0.76–1.40)
Personal control	1.00 (0.93–1.07)	1.02 (0.94–1.10)	0.88 (0.69–1.11)	0.87 (0.60–1.26)	1.01 (0.93–1.09)	1.03 (0.94–1.13)	0.87 (0.70–1.08)	0.80 (0.61–1.05)
Treatment control	1.09 (0.98–1.21)	1.07 (0.95–1.20)	1.16 (0.75–1.80)	1.19 (0.60–2.33)	1.07 (0.96–1.19)	1.04 (0.92–1.18)	1.25 (1.01–1.55)*	1.38 (1.04–1.84)*
Identity	1.29 (1.17–1.43)*	1.26 (1.20–1.41)*	1.57 (1.17–2.10)*	1.21 (0.78–1.85)	1.26 (1.12–1.42)*	1.26 (1.11–1.43)*	1.30 (0.92–1.85)	1.30 (0.82–2.05)
Concern	1.03 (0.91–1.16)	1.00 (0.88–1.15)	0.74 (0.51–1.08)	0.55 (0.29–1.02)	1.09 (0.95–1.25)	1.06 (0.91–1.24)	0.90 (0.63–1.28)	0.98 (0.65–1.49)
Coherence	1.13 (1.04–1.22)*	1.11 (1.02–1.21)*	1.35 (1.06–1.72)*	1.48 (0.99–2.21)	1.10 (1.00–1.20)	1.09 (0.99–1.20)	0.99 (0.80–1.22)	0.82 (0.60–1.11)
Emotional representations	1.10–0.98–1.24)	0.94 (0.82–1.08)	1.25 (0.89–1.77)	1.15 (0.68–1.95)	1.07 (0.94–1.22)	0.93 (0.80–1.08)	1.24 (0.91–1.70)	0.98 (0.64–1.52)
Psychological variables
Symptoms of anxiety	—	1.16 (1.05–1.28)*	—	1.20 (0.87–1.67)	—	1.15 (1.03–1.29)*	—	1.12 (0.84–1.49)
Symptoms of depression	—	1.33 (1.20–1.48)*	—	2.55 (1.50–4.34)*	—	1.28 (1.15–1.43)*	—	1.67 (1.24–2.26)*
Sociodemographics
Age	1.24 (0.79–1.96)	1.56 (0.93–2.64)	1.02 (0.97–1.07)	1.01 (0.94–1.09)	1.01 (0.99–1.04)	1.00 (0.98–1.03)	0.98 (0.91–1.04)	0.93 (0.85–1.01)
Sex	1.01 (0.99–1.03)	1.00 (0.98–1.02)	1.71 (0.48–6.07)	3.10 (0.53–18.07)	1.17 (0.70–1.94)	1.39 (0.78–2.47)	1.83 (0.61–5.44)	3.11 (0.71–13.64)
Education (ref. = lower)
Secondary	0.82 (0.41–1.62)	0.97 (0.45–2.11)	0.19 (0.01–2.75)	0.11 (0.00–14.37)	0.88 (0.42–1.85)	0.95 (0.42–2.15)	3.34 (0.67–16.81)	2.97 (0.37–23.59)
High	0.68 (0.31–1.51)	1.25 (0.50–3.13)	0.25 (0.02–4.08)	0.34 (0.00–42.72)	0.75 (0.31–1.80)	1.30 (0.49–3.45)	1.20 (0.18–7.90)	1.03 (0.09–12.29)
Marital status	1.43 (0.84–2.44)	1.78 (0.97–3.25)	0.97 (0.27–3.45)	2.50 (0.35–18.03)	1.42 (0.76–2.66)	1.81 (0.90–3.64)	0.96 (0.28–3.35)	0.51 (0.10–2.70)
Employment	1.07 (0.61–1.90)	1.57 (0.83–2.96)	1.33 (0.27–6.57)	1.30 (0.12–14.18)	1.30 (0.66–2.55)	1.82 (0.87–3.78)	1.30 (0.26–6.56)	2.22 (0.31–15.72)
Clinical variables
Time diagnosis	1.10 (1.01–1.19)*	1.00 (0.98–1.02)	1.01 (0.82–1.23)	1.01 (0.75–1.37)	1.12 (1.02–1.23)*	1.08 (0.97–1.20)	1.25 (0.99–1.57)	1.19 (0.90–1.57)
Disease stage (ref. = 1)
Stage 2	0.85 (0.48–1.52)	0.95 (0.50–1.79)	0.88 (0.20–3.82)	0.45 (0.05–4.21)	0.78 (0.39–1.55)	0.98 (0.47–2.05)	Na	Na
Stage 3	1.66 (0.88–3.14)	1.39 (0.69–2.82)	1.20 (0.18–8.16)	0.14 (0.01–2.75)	1.71 (0.84–3.47)	1.58 (0.73–3.44)	Na	Na
Stage 4	1.70 (0.96–3.04)	1.75 (0.92–3.32)	3.19 (0.30–33.70)	7.47 (0.29–190.52)	1.75 (0.95–3.21)	1.81 (0.93–3.53)	Na	Na
BMI	1.09 (1.03–1.14)*	1.13 (1.07–1.20)*	1.17 (1.03–1.33)*	1.44 (1.12–1.86)*	1.08 (1.02–1.14)*	1.11 (1.05–1.18)*	0.94 (0.82–1.08)	0.93 (0.77–1.14)
# Comorbidities (ref = 0)
1	1.99 (1.18–3.38)*	1.86 (1.04–3.32)*	6.23 (1.40–27.82)*	9.94 (1.01–97.36)*	1.65 (0.91–2.99)	1.57 (0.83–2.98)	2.01 (0.49–8.25)	1.02 (0.19–5.56)
≥ 2	2.54 (1.45–4.43)*	1.86 (0.99–3.47)	6.68 (1.01–44.00)*	6.76 (0.18–253.89)	2.24 (1.21–4.12)*	1.73 (0.88–3.37)	3.88 (0.98–15.32)	3.01 (0.60–15.10)

For the CLL group no tumour stage was available, to include this patient sample in the total group analyses we provided a fictitious missing value for them. CLL: chronic lymphocytic leukaemia; HL: Hodgkin lymphoma; NHL: non–Hodgkin lymphoma; ref.: reference group.

* p < .05.

Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003;41(5):582–592.

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