Persistent fatigue among long-term non-Hodgkin lymphoma survivors

Abstract

This study describes the prevalence and persistence of fatigue among a cohort of long-term non-Hodgkin lymphoma (NHL) survivors. Mailed surveys assessed quality-of-life including fatigue (SF-36) at baseline and five years. Logistic regression was used to identify factors associated with prevalence of fatigue at baseline and persistence of fatigue across timepoints. More than one-quarter (27.7%) of the 555 NHL survivors reported clinically meaningful fatigue at baseline and 18.7% reported persistent fatigue at five years. One-third (34.4%) reported clinically meaningful worsening of fatigue over time. Independent associations with persistent fatigue included female gender, less education, past chemotherapy, increased comorbidities, and posttraumatic stress symptoms (P <.05). Our findings suggest that one in three NHL survivors experience clinically meaningful fatigue long after their diagnosis and initial treatment. Furthermore, we found that fatigue worsens or persists for many, highlighting the need for vigilance in assessing and treating fatigue in this population.

Keywords:

• Non-Hodgkin lymphoma
• fatigue
• survivorship
• symptoms
• oncology

Ethical approval

This study was conducted with approval from the Duke University Institutional Review Board (Pro00006538) and the University of North Carolina at Chapel Hill Institutional Review Board (01-1269) and in accordance with the 1964 Declaration of Helsinki and its later

Author contributions

All authors contributed to the study conception and design. Material preparation and analysis were performed by Matthew R. LeBlanc. The first draft of the manuscript was written by Matthew R. LeBlanc and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Disclosure statement

Financial interests: S.Z. and S.K.S. declare they have no financial interests. K.H. and T.W.L. received personal fees from Daiichi-Sankyo. A.L.B. received consulting honoraria from Servier Pharmaceuticals. M.R.L. has research funding from the American Cancer Society and NINR/NIR. T.W.L. has received consulting honoraria from Agios, AstraZeneca, CareVive, Flat Iron, Helsinn, Otsuka, Pfizer, Seattle Genetics, Welvie, Abbvie, Amgen, Daiichi-Sanyo, Heron, Medtronic, research funding through the American Cancer Society, Duke University, NIH NINR/NIR, Jazz Pharmaceuticals, Seattle Genetics, speaking honoraria from Abive, Agios, BMS, Celgene and Royalties from UpToDate.

Figure 1. CONSORT diagram.

Code availability

Statistical analyses were done in SAS 9.4 (Cary, NC).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

No identifying information or data is included in this manuscript.

Data availability statement

Study data are not publicly available.

Additional information

Funding

This work was supported by Grant No. R03CA101492 and Cancer Care Quality Fellowship R25CA116339 from the National Cancer Institute, Grant No. DSW-0321301-SW from the American Cancer Society, Grant No. 10KR71019 from the University of North Carolina (UNC) Translational and Clinical Sciences Institute, and an award from the UNC Research Council. Dr. Matthew R. LeBlanc was supported by UNC's Cancer Care Quality Training [5T32CA116339–14], National Institute of Nursing [F31NR018576], and an American Cancer Society Doctoral Degree Scholarship in Cancer Nursing [DSCN-19-045-01-SCN].