Patient-reported distress in Hodgkin lymphoma across the survivorship continuum

• Published in: Supportive care in cancer Vol. 27; no. 7; pp. 2453 - 2462
• Main Authors: Troy, Jesse D., Locke, Susan C., Samsa, Greg P., Feliciano, Joseph, Richhariya, Akshara, LeBlanc, Thomas W.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2019; Springer; Springer Nature B.V
• Subjects: Blood cancer; Care and treatment; Comparative analysis; Health aspects; Lymphoma; Measuring instruments; Medical colleges; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Non-Hodgkin's lymphomas; Nursing; Nursing Research; Oncology; Original; Original Article; Pain Medicine; Patients; Rehabilitation Medicine; Survivor; Psychological distress; Hematologic neoplasms; Patient-reported outcome measures; Hodgkin lymphoma; Quality of life
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-018-4523-4

Purpose
Hodgkin lymphoma (HL) survivors face long-term, elevated risk of treatment-related sequelae, including psychosocial distress associated with poor health outcomes. The magnitude and sources of distress are not well described in the routine care of HL outside of clinical trials.
Methods
We conducted a retrospective cohort study of patients visiting a tertiary-care center for treatment or long-term follow-up of HL. Patient-reported distress was documented using the National Comprehensive Cancer Network Distress Thermometer (DT) and Problem List. Three survivor groups were compared using descriptive methods: on treatment, surviving < 5 years, and surviving ≥ 5 years since diagnosis.
Results
A total of 1524 DT were abstracted for 304 patients (106 on treatment, 77 surviving < 5 years, and 121 surviving ≥ 5 years). Distress was low overall (median DT = 1, inter-quartile range 0–4) and was similar across survivor groups. However, actionable distress (score ≥ 4) was reported at 29.5% of clinical encounters. Patients on treatment more frequently reported actionable distress (32.5% of visits) compared with patients surviving < 5 years (20.4%) and ≥ 5 years (28.7%) (
P
 = 0.065). Distress was associated primarily with physical and emotional problems, especially fatigue, worry, and sleep. We did not observe any associations between distress and clinical prognostic factors.
Conclusions
Distress burden is low in HL, but survivorship is marked by periods of actionable distress, largely related to physical symptoms and emotional issues. This burden may be higher when on treatment and is unrelated to disease-related prognostic factors. Survivorship research typically focuses on the post-therapy period, but our results support testing the efficacy of interventions to address distress in HL during active treatment as well.