Systematic literature review of health-related quality of life among aggressive non-Hodgkin lymphoma survivors

Figures & data

Figure 1. Flow diagram.

Abbreviations. CNS, central nervous system; HRQoL, health-related quality of life; NHL, Non-Hodgkin lymphoma; QOL, quality of life.

Table 1. Synthesized longitudinal and cross-sectional studies, by time from diagnosis and follow-up.

										Risk of bias				Compare to general population
Reference	Publication type	Study type	Country	Industry funding	Population (% aggressive)	N (% response)	Years from diagnosis^a	Follow-up (years)^b	Instrument	Sel.	Perf.	Att.	Det.
Longitudinal studies
Ruan et al., 2015^13	Journal article	LS	US	Yes	MCL (NR)	38 (84)	–	2	FACT-Lym	L	L	U	L	No
Thompson et al., 2015^6	Abstract	LS	US	NR	NHL (100)	1902 (25)	–	3	FACT-G	L	U	U	L	Yes
Heutte et al., 2011^5	Journal article	RCT	France	No	DLBCL (NR)	200 (74)	–	3	EORTC QLQ-C30	L	L	U	L	Yes
Oerlemans et al., 2014^14	Journal article	LS	Netherlands	No	DLBCL (NR)	305 (85)	2.6	1	EORTC QLQ-C30	–	–	–	–	Yes
Oerlemans et al., 2014^15	Journal article	LS	Netherlands	No	DLBCL (NR)	364 (85)	3.5	4	EORTC QLQ-C30	–	–	–	–	No
									HADS	L	L	U	L	Yes
Hudson et al., 2015^16	Abstract	LS	US	NR	NHL (NR)	682 (NR)	10.4	5	SF-36 Fatigue	L	U	U	L	No
Cross-sectional studies
Holland et al., 2016^17	Abstract	CS	Ireland	NR	NHL (NR)	85 (55)	range =1–5+	–	FACT-G	U	U	U	L	Yes
									FACT-Lym	U	U	U	L	Yes
Glaser et al., 2013^18	Journal article	CS	UK	No	NHL (NR)	1248 (62)	2.8	–	EQ-5D	L	L	U	L	No
Jefford et al., 2017^19	Journal article	CS	Australia	No	NHL (NR)	586 (40)	3.2	–	EQ-5D-5L	L	U	U	L	No
Jensen et al., 2013^20	Journal article	CS	US	No	NHL (100)	744 (43)	3.5	–	SF-36	U	U	U	L	No
Kim et al., 2014^21	Journal article	CS	Korea	No	93 NHL (81)	3054 (27)	6.3	–	EORTC QLQ-C30	L	L	U	L	Yes
Mols et al., 2007^11	Journal article	CS	Netherlands	No	NHL (58)	360 (82)	8.8	–	SF-36	L	L	U	L	Yes
									QOL-CS	L	L	U	L	No
Beaven et al., 2016^22	Journal article	CS	US	No	NHL (65)	886 (62)	10.2	–	FACT-G	U	U	U	L	No
									FACT-Lym	U	U	U	L	No
Smith et al., 2010^23	Journal article	CS	US	No	NHL (55)	1312 (50)	10.8	–	SF-36	L	L	U	L	No
									FACT-G	L	L	U	L	No

^aCalculated for Mols et al.¹¹, Glaser et al.¹⁸ and Jefford et al.¹⁹.

^bBaseline is diagnosis except for Heutte et al.⁵ which reports follow-up from treatment.

Abbreviations. Att., attrition; CS, cross-sectional; Det., detection; DLBCL, diffuse large B-cell lymphoma; L, low risk of bias; LS, longitudinal; MCL, mantle cell lymphoma; NHL, non-Hodgkin lymphoma; NR, not reported; Perf., performance; RCT, randomized clinical trial; Sel., selection; U, unclear/unknown risk.

Table 2. Overall HRQoL trends among survivors and comparison to general population, adjusted analyses in bold.

				Overall HRQoL^c
Reference	Years from diagnosis^a	Years follow-up^b	Instrument	Survivor trend	Compare to general population
Longitudinal studies
Ruan et al., 2015^13	–	2	FACT-Lym	No change (NR)
Thompson et al., 2015^6	–	3	FACT-G	Improvement (p < .0001)	BL: better (p = .0033) 3 yrs: better (p < .0001)
Heutte et al., 2011^5	–	3	EORTC QLQ-C30	Improvement (p = .0020)	1 yr: comparable (NR)
Oerlemans et al., 2014^14	2.6	1	EORTC QLQ-C30	–	2.6 yrs: worse (p < .05)
Cross-sectional studies
Holland et al., 2016^17	range =1–5+	–	FACT-Lym	Improvement (1–2 yrs: ref 2–3 yrs: ns 3–4 yrs: ns 4–5 yrs: ns 5 yrs: p < .05)
Glaser et al., 2013^18	2.8	–	EQ-5D	Improvement (1 yr: ref 2 yrs: ns 3 yrs: p=.03 5 yrs: p=.02)
Jefford et al., 2017^19	3.2	–	EQ-5D-5L	Improvement (NR)
Jensen et al., 2013^20	3.5	–	SF-36	No change (NR)
Kim et al., 2014^21	6.3	–	EORTC QLQ-C30	–	Better (p = .001)
Mols et al., 2007^11	8.8	–	SF-36	No change (ns)	Comparable (ns)
			QOL-CS	No change (ns)
Beaven et al., 2016^22	10.2	–	FACT-G	No change (NR)
			FACT-Lym	No change (NR)
Smith et al., 2010^23	10.8	–	SF-36	No change (ns)
			FACT-G	No change (NR)

^aCalculated for Mols et al.¹¹, Glaser et al.¹⁸ and Jefford et al.¹⁹.

^bBaseline is diagnosis except for Heutte et al.⁵ which reports follow-up from treatment.

^cAlso showing health utility results for Glaser et al.¹⁸ and Jefford et al.¹⁹.

Abbreviations. BL, baseline; NR, not reported; ns, not significant (p ≥ .05); ref, reference group.

Table 3. HRQoL domain trends among survivors and comparison to general population, adjusted analyses in bold.

				Physical		Cognitive		Social		Emotional
Reference	Years from diagnosis^a	Years follow-up^b	Instrument	Survivor trend	Compared to general population	Survivor trend	Compared to general population	Survivor trend	Compared to general population	Survivor trend	Compared to general population
Longitudinal studies
Thompson et al., 2015^6	–	3	FACT-G	Improvement (p < .0001)	BL: worse (p = .0003) 3 yrs: better (p < .0001)			Deterioration (p < .0001)	BL: better (p < .0001) 3 yrs: better (p < .0001)	Improvement (p < .0001)	BL: worse (p < .0001) 3 yrs: better (p < .039)
Heutte et al., 2011^5	–	3	EORTC QLQ-C30	Improvement (p < .0001)	1 yr: comparable (NR)	No change (ns)		Improvement (p = .0110)		Deterioration (ns)
Oerlemans et al., 2014^14	2.6	1	EORTC QLQ-C30		2.6 yrs: worse (p < .05)		2.6 yrs: worse (p < .05)		2.6 yrs: worse (p < .05)		2.6 yrs: worse (p < .05)
Cross-sectional studies
Holland et al., 2016^17	range =1–5+	–	FACT-G	Improvement (1–2 yrs: ref 2–3 yrs: ns 3–4 yrs: ns 4–5 yrs: ns 5 + yrs: ns)	Better (NR)			Improvement (1–2 yrs: ref 2–3 yrs: ns 3–4 yrs: ns 4–5 yrs: ns 5 + yrs: ns)		Improvement (1–2 yrs: ref 2–3 yrs: ns 3–4 yrs: p < .05 4–5 yrs: ns 5 + yrs: p < .05)	Better (NR)
Jefford et al., 2017^19	3.2	–	EQ-5D-5L			Improvement (NR)				No change (NR)
Kim et al., 2014^21	6.3	–	EORTC QLQ-C30	Improvement (NR)	Comparable (ns)		Worse (p < .001)	Improvement (NR)	Worse (p < .001)		Worse (p = .001)
Mols et al., 2007^11	8.8	–	SF-36	No change (ns)	Comparable (ns)			No change (ns)	Comparable (ns)	No change (ns)	Comparable (ns)
			QOL-CS	No change (ns)				Improvement (p < .01)		Improvement (p < .05)
Beaven et al., 2016^22	10.2	–	FACT-G	No change (NR)				No change (NR)		No change (NR)

^aCalculated for Mols et al.¹¹ and Jefford et al.¹⁹.

^bBaseline is diagnosis except for Heutte et al.⁵ which reports follow-up from treatment; fear of relapse¹⁹ and psychological¹¹ included with emotional domain; trouble concentrating¹⁹ included with cognitive domain.

Abbreviations. BL, baseline; NR, not reported; ns, not significant (p ≥ .05); ref, reference group.

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