Impact of individualized treatment on recovery from fatigue and return to work in survivors of advanced stage Hodgkin Lymphoma: results from the randomized international GHSG HD18 trial.

Hodgkin lymphoma fatigue quality of life recovery return to work survivorship

Journal

Annals of oncology : official journal of the European Society for Medical Oncology
ISSN: 1569-8041
Titre abrégé: Ann Oncol
Pays: England
ID NLM: 9007735

Informations de publication

Date de publication:
05 Dec 2023
Historique:
received: 18 09 2023
revised: 01 11 2023
accepted: 29 11 2023
medline: 8 12 2023
pubmed: 8 12 2023
entrez: 7 12 2023
Statut: aheadofprint

Résumé

Persisting cancer-related fatigue impairs health related quality of life (HRQoL) and social re-integration in patients with Hodgkin lymphoma (HL). The GHSG HD18 trial established PET-2 guided treatment de-escalation for advanced-stage HL as new standard. Here, we investigate the impact of treatment de-escalation on long-term HRQoL, time-to-recovery from fatigue (TTR-F) and time-to-return to work (TTR-W). Patients received EORTC QLQ-C30 and life situation questionnaires at baseline, interim, end-of-treatment, and yearly follow-up. TTR-F was defined as time from end of chemotherapy until the first fatigue score < 30. TTR-W was analyzed in previously working or studying patients and measured from end of treatment until first documented work or education. We compared duration of treatment on TTR-F and TTR-W using Cox proportional hazards regression adjusted for confounding variables. HRQoL questionnaires at baseline were available in 1632 (83.9%) of all randomized patients. Overall, higher baseline fatigue and age were significantly associated with longer TTR-F and TTR-W and male sex with shorter TTR-W. Treatment reduction from eight to four chemotherapy cycles led to a significantly shorter TTR-F (HR 1.41, p=0.008) and descriptively shorter TTR-W (HR 1.24, p=0.084) in PET-2 negative patients. Reduction from six to four cycles led to non-significant but plausible intermediate accelerations. Addition of Rituximab caused significantly slower TTR-F (HR 0.70, p=0.0163) and TTR-W (HR 0.64, p = 0.0017) in PET-2 positive patients. HRQoL at baseline and age were the main determinants of 2y HRQoL. Individualized first-line treatment in patients with advanced-stage HL considerably shortens TTR-F and TTR-W in PET-2 negative patients. Our results support the use of response-adapted shortened treatment duration for patients with HL.

Sections du résumé

BACKGROUND BACKGROUND
Persisting cancer-related fatigue impairs health related quality of life (HRQoL) and social re-integration in patients with Hodgkin lymphoma (HL). The GHSG HD18 trial established PET-2 guided treatment de-escalation for advanced-stage HL as new standard. Here, we investigate the impact of treatment de-escalation on long-term HRQoL, time-to-recovery from fatigue (TTR-F) and time-to-return to work (TTR-W).
PATIENTS AND METHODS METHODS
Patients received EORTC QLQ-C30 and life situation questionnaires at baseline, interim, end-of-treatment, and yearly follow-up. TTR-F was defined as time from end of chemotherapy until the first fatigue score < 30. TTR-W was analyzed in previously working or studying patients and measured from end of treatment until first documented work or education. We compared duration of treatment on TTR-F and TTR-W using Cox proportional hazards regression adjusted for confounding variables.
RESULTS RESULTS
HRQoL questionnaires at baseline were available in 1632 (83.9%) of all randomized patients. Overall, higher baseline fatigue and age were significantly associated with longer TTR-F and TTR-W and male sex with shorter TTR-W. Treatment reduction from eight to four chemotherapy cycles led to a significantly shorter TTR-F (HR 1.41, p=0.008) and descriptively shorter TTR-W (HR 1.24, p=0.084) in PET-2 negative patients. Reduction from six to four cycles led to non-significant but plausible intermediate accelerations. Addition of Rituximab caused significantly slower TTR-F (HR 0.70, p=0.0163) and TTR-W (HR 0.64, p = 0.0017) in PET-2 positive patients. HRQoL at baseline and age were the main determinants of 2y HRQoL.
CONCLUSIONS CONCLUSIONS
Individualized first-line treatment in patients with advanced-stage HL considerably shortens TTR-F and TTR-W in PET-2 negative patients. Our results support the use of response-adapted shortened treatment duration for patients with HL.

Identifiants

DOI: 10.1016/j.annonc.2023.11.014 PMID: 38061428
pubmed: 38061428
pii: S0923-7534(23)05102-5
doi: 10.1016/j.annonc.2023.11.014
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 European Society for Medical Oncology. Published by Elsevier Ltd. All rights reserved.

Auteurs

J Ferdinandus (J)

Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), Cologne, Germany. Electronic address: justin.ferdinandus@uk-koeln.de.

H Müller (H)

Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), Cologne, Germany.

C Damaschin (C)

Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), Cologne, Germany.

A S Jacob (AS)

Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), Cologne, Germany.

J Meissner (J)

Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany.

F Krasniqi (F)

Medical Oncology, University Hospital of Basel, Basel, Switzerland; Swiss Group for Clinical Cancer Research.

U Mey (U)

Swiss Group for Clinical Cancer Research; Oncology and Hematology, Kantonsspital Graubuenden, Chur, Switzerland.

D Schöndube (D)

Department of Oncology and Hematology, Helios Klinikum Bad Saarow, Bad Saarow, Germany.

J Thiemer (J)

Department of Hematology and Oncology, Klinikum der Philipps-Universität Marburg, Marburg, Germany.

S Mathas (S)

Charité - Universitätsmedizin Berlin, Hematology, Oncology and Tumor Immunology, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Group Biology of Malignant Lymphomas, Berlin, Germany; Experimental and Clinical Research Center (ECRC), a cooperation between the MDC and the Charité.

J Zijlstra (J)

Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands.

R Greil (R)

Illrd Medical Department, Paracelsus Medical University, Salzburg Austria; Salzburg Cancer Research Institute and AGMT, Salzburg, Austria.

M Feuring-Buske (M)

Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany.

J Markova (J)

Department of Internal Medicine-Hematology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic.

J U Rüffer (JU)

German Fatigue Society, Cologne, Germany.

C Kobe (C)

German Hodgkin Study Group (GHSG), Cologne, Germany; Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany.

H-T Eich (HT)

German Hodgkin Study Group (GHSG), Cologne, Germany; Department of Radiotherapy, University Hospital of Muenster, Muenster, Germany.

C Baues (C)

German Hodgkin Study Group (GHSG), Cologne, Germany; Department of Radiooncology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany.

M Fuchs (M)

Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), Cologne, Germany.

P Borchmann (P)

Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), Cologne, Germany.

K Behringer (K)

Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), Cologne, Germany.

Classifications MeSH