Health and psychosocial outcomes and their relationship to quality of life in survivors of adult aggressive lymphoma

Purpose. The purpose of this study is to describe the incidence of chronic health conditions and psychosocial issues (anxiety, depression, and post-traumatic stress disorder) in a population of cured survivors of adult lymphoma, and explore the impact of these on overall health-related quality of life (QOL). We hypothesize that QOL is decreased in lymphoma patients who have long-term consequences of treatment, including physical complications, the presence of anxiety, symptoms of post-traumatic stress disorder (PTSD), and depression. Important modifying factors are fatigue, the patient-physician relationship, and physical exercise.;Patients and methods. A cross-sectional interview of 70 participants at Weill Cornell Medical Center (n=57) and across the United States (n=13) who were who were long-term lymphoma survivors (mean 6.7 +/- 5.6 years after diagnosis) was performed using standardized instruments. Data collected included demographics, treatment sequelae (health conditions that occurred as a result of cancer treatment), anxiety symptoms, depressive symptoms, post-traumatic stress disorder (PTSD) symptoms, fatigue level, exercise habits, comorbid health conditions, the doctor-patient relationship, and QOL as measured by the QOL-Cancer Survivor questionnaire. Treatment history was collected by chart abstraction and self-report. Multivariate linear regression modeling was used to identify variables associated with the QOL overall score. A path analysis model was constructed to describe the relative contribution of each variable to overall QOL and examine interrelations between the variables.;Results. 53% of participants reported moderate or severe fatigue, significantly greater than population norms. 37% had clinically significant anxiety symptoms, 16%had moderate PTSD symptoms related to the lymphoma, and 9% reported clinically significant depressive symptoms. Overall QOL scores were comparable to mean cancer patient norms. By multivariate stepwise regression, in order of degree of contribution, more anxiety symptoms, greater fatigue, more PTSD symptoms, higher number of treatment regimens, and less exercise significantly correlated with lower QOL, accounting for 71% of the variance. A causal path model to predict overall QOL in the presence of these factors with a temporal sequence was constructed.;Conclusion. There is a high prevalence of fatigue, anxiety, and PTSD symptoms in this population of cured long-term lymphoma survivors, which negatively influence overall QOL. The number of cancer survivors is increasing and new interventions that address the complex relationship between psychosocial issues and physical health conditions are needed to improve QOL.