Coping and Perception of Prognosis in Patients With Indolent Non-Hodgkin's Lymphoma

BACKGROUND

Indolent non-Hodgkin's lymphomas (iNHL) are a heterogenous group of mostly incurable diseases with prolonged illness courses and prognostic uncertainty. Yet, studies evaluating coping and perception of prognosis are limited.

METHODS

We conducted a cross-sectional study of adults newly diagnosed with iNHL in the past 3 months at a single academic center. We assessed quality of life (QOL: Functional Assessment of Cancer Therapy-General), psychological symptoms (Hospital Anxiety and Depression Scale), coping (Brief-COPE), and perception of prognosis (Prognosis Awareness Impact Scale).

RESULTS

We enrolled 70.6% (48/68) of eligible patients. Patients had older age (mean = 66.9,sd = 10.5), were female (60.4%), predominantly identified as White (85.4%), and had at least received a college degree (75%). Chronic lymphocytic leukemia (39.6%) and follicular lymphoma (33.3%) were the most common diagnoses. Overall, 27.1% and 14.6% of patients reported clinically significant anxiety and PTSD symptoms, respectively. Patients highly utilized acceptance (56.2%), seeking emotional support (47.9%), and denial (47.9%) as coping strategies at diagnosis. While 66.7% of patients recalled their oncologist assessment of illness as incurable, only 35.4% reported that the illness is unlikely to be cured. Overall, 45.8% indicated that they were worried about prognosis and 31.2% reported perseverating on their prognosis. Higher emotional coping with prognosis was associated with fewer anxiety (B = -0.6, SE = 0.2, P < .001), depression (B = -0.3, SE = .1, P = .005), and PTSD (B = -1.3, SE = 0.4, P < .001) symptoms and better QOL (B = 1.7, SE = 0.4, P < .001).

DISCUSSION

Patients with iNHL report substantial psychological distress, a diversity of coping strategies, and complex cognitive understanding of their prognosis. Interventions, which address prognostic uncertainty and promote positive emotional coping with prognosis, may ameliorate psychological distress in this population.

Acute, long-term or non-vincristine-induced peripheral neuropathy among non-Hodgkin lymphoma survivors: Symptoms, daily activities, functional status, and quality of life

PURPOSE

This study aimed to explore the incidence and severity of vincristine-induced peripheral neuropathy (VIPN) in non-Hodgkin lymphoma (NHL) survivors (primary aim) and its impact on daily life by comparing common cancer symptoms, functional status, and quality of life (QoL) among survivors with acute, long-term, and non-VIPN (secondary aim).

METHODS

This cross-sectional study examined 144 NHL survivors. Standardized questionnaires were used to assess common cancer symptoms, functional status, and QoL with the European Organization for the Research and Treatment of Cancer - Quality of Life Questionnaire (EORTC-QLQ-C30). VIPN (Chemotherapy-Induced Peripheral Neuropathy) status was classified using EORTC-QLQ-CIPN20. A self-designed interference scale was developed to determine the impact of the VIPN on daily activities. The Kruskal-Wallis test and Spearman rank correlation were used in this study.

RESULTS

Among the survivors of acute and long-term VIPN, the highest incidences and most severe symptoms were found for hand numbness and foot cramps. A significant moderate correlation was found between disturbances in daily activities and acute or long-term VIPN, including gait changes, going up or down the stairs, and imbalance-related falls. Acute and long-term VIPN survivors showed worse symptoms (fatigue, insomnia, and constipation) and lower QoL than non-VIPN survivors did. In acute VIPN, social function was significantly affected, whereas in long-term VIPN, emotional and cognitive functions were affected.

CONCLUSION

Numbness and cramps should be addressed in survivors of acute and long-term VIPN. Preventing falls is recommended for NHL survivors with VIPN, and psychological support is suggested for long-term VIPN survivors.

Exploring the relationship between social support and mental health status among lymphoma survivors: Does patient-centered communication really matter? A brief report

The purpose of this study was to explore whether patient-centered communication (PCC) would partially mediate the relationship between social support and mental health status among adult survivors of non-Hodgkin's lymphoma (NHL). Methods: Secondary analysis of self-administered questionnaires mailed to 682 adults with NHL who were assumed living and had completed the baseline 2005 study (83% response rate). Adult NHL survivors (n = 566) and data were analyzed using descriptive statistics and the Sobel test. Results: PCC partially mediated the relationship between social support and three measures of mental health outcomes (SF-36 Mental Component Summary [SF36-MCS], Post-Traumatic Stress Disorder Checklist-Civilian Version [PCL-C], Impact of Cancer - Negative Impact Summary [IOCv2 NIS]). Results of the conservative Sobel test were significant (p < .01) in three mediation models. Conclusions: Future research should focus on testing interventions that target PCC and identifying additional mediators and moderators between social support and mental health outcomes among cancer survivors.

Real time remote symptom monitoring during chemotherapy for cancer: European multicentre randomised controlled trial (eSMART)

OBJECTIVE

To evaluate effects of remote monitoring of adjuvant chemotherapy related side effects via the Advanced Symptom Management System (ASyMS) on symptom burden, quality of life, supportive care needs, anxiety, self-efficacy, and work limitations.

DESIGN

Multicentre, repeated measures, parallel group, evaluator masked, stratified randomised controlled trial.

SETTING

Twelve cancer centres in Austria, Greece, Norway, Republic of Ireland, and UK.

PARTICIPANTS

829 patients with non-metastatic breast cancer, colorectal cancer, Hodgkin's disease, or non-Hodgkin's lymphoma receiving first line adjuvant chemotherapy or chemotherapy for the first time in five years.

INTERVENTION

Patients were randomised to ASyMS (intervention; n=415) or standard care (control; n=414) over six cycles of chemotherapy.

MAIN OUTCOME MEASURES

The primary outcome was symptom burden (Memorial Symptom Assessment Scale; MSAS). Secondary outcomes were health related quality of life (Functional Assessment of Cancer Therapy-General; FACT-G), Supportive Care Needs Survey Short-Form (SCNS-SF34), State-Trait Anxiety Inventory-Revised (STAI-R), Communication and Attitudinal Self-Efficacy scale for cancer (CASE-Cancer), and work limitations questionnaire (WLQ).

RESULTS

For the intervention group, symptom burden remained at pre-chemotherapy treatment levels, whereas controls reported an increase from cycle 1 onwards (least squares absolute mean difference -0.15, 95% confidence interval -0.19 to -0.12; P<0.001; Cohen's D effect size=0.5). Analysis of MSAS sub-domains indicated significant reductions in favour of ASyMS for global distress index (-0.21, -0.27 to -0.16; P<0.001), psychological symptoms (-0.16, -0.23 to -0.10; P<0.001), and physical symptoms (-0.21, -0.26 to -0.17; P<0.001). FACT-G scores were higher in the intervention group across all cycles (mean difference 4.06, 95% confidence interval 2.65 to 5.46; P<0.001), whereas mean scores for STAI-R trait (-1.15, -1.90 to -0.41; P=0.003) and STAI-R state anxiety (-1.13, -2.06 to -0.20; P=0.02) were lower. CASE-Cancer scores were higher in the intervention group (mean difference 0.81, 0.19 to 1.43; P=0.01), and most SCNS-SF34 domains were lower, including sexuality needs (-1.56, -3.11 to -0.01; P<0.05), patient care and support needs (-1.74, -3.31 to -0.16; P=0.03), and physical and daily living needs (-2.8, -5.0 to -0.6; P=0.01). Other SCNS-SF34 domains and WLQ were not significantly different. Safety of ASyMS was satisfactory. Neutropenic events were higher in the intervention group.

CONCLUSIONS

Significant reduction in symptom burden supports the use of ASyMS for remote symptom monitoring in cancer care. A "medium" Cohen's effect size of 0.5 showed a sizable, positive clinical effect of ASyMS on patients' symptom experiences. Remote monitoring systems will be vital for future services, particularly with blended models of care delivery arising from the covid-19 pandemic.

TRIAL REGISTRATION

Clinicaltrials.gov NCT02356081.

Patient-Reported Neuropsychiatric Outcomes of Long-Term Survivors after Chimeric Antigen Receptor T Cell Therapy

CD19-targeted chimeric antigen receptor (CAR) modified T cell immunotherapy is a novel treatment with promising results in patients with relapsed/refractory lymphoid malignancies. CAR T cell therapy has known early toxicities of cytokine release syndrome and neurotoxicity, but little is known about long-term neuropsychiatric adverse effects. We have used patient-reported outcomes, including Patient-Reported Outcomes Measurement Information System (PROMIS) measures, to assess neuropsychiatric and other patient-reported outcomes of 40 patients with relapse/refractory chronic lymphocytic leukemia, non-Hodgkin lymphoma, and acute lymphoblastic leukemia 1 to 5 years after treatment with CD19-targeted CAR T cells. Mean T scores of PROMIS domains of global mental health, global physical health, social function, anxiety, depression, fatigue, pain, and sleep disturbance were not clinically meaningfully different from the mean in the general US population. However, 19 patients (47.5%) reported at least 1 cognitive difficulty and/or clinically meaningful depression and/or anxiety, and 7 patients (17.5%) scored ≤40 in global mental health, indicating at least 1 standard deviation worse than the general population mean. Younger age was associated with worse long-term global mental health (P = .02), anxiety (P = .001), and depression (P= .01). Anxiety before CAR T cell therapy was associated with increased likelihood of anxiety after CAR T cell therapy (P = .001). Fifteen patients (37.5%) reported cognitive difficulties after CAR T cell therapy. Depression before CAR T cell therapy was statistically significantly associated with higher likelihood of self-reported post-CAR T cognitive difficulties (P = .02), and there was a trend for an association between acute neurotoxicity and self-reported post-CAR T cognitive difficulties (P = .08). Having more post-CAR T cognitive difficulties was associated with worse global mental health and global physical health. Our study demonstrates overall good neuropsychiatric outcomes in 40 long-term survivors after CAR T cell therapy. However, nearly 50% of patients in the cohort reported at least 1 clinically meaningful negative neuropsychiatric outcome (anxiety, depression, or cognitive difficulty), indicating that a significant number of patients would likely benefit from mental health services following CAR T cell therapy. Younger age, pre-CAR T anxiety or depression, and acute neurotoxicity may be risk factors for long-term neuropsychiatric problems in this patient population. Larger studies are needed to confirm these findings.

Fatigue level changes with time in long-term Hodgkin and non-Hodgkin lymphoma survivors: a joint EORTC-LYSA cross-sectional study

BACKGROUND

Long-term lymphoma survivors often complain of persistent fatigue that remains unexplained. While largely reported in Hodgkin lymphoma (HL), long-term fatigue is poorly documented in non-Hodgkin lymphomas (NHL). Data collected in two cohort studies were used to illustrate the fatigue level changes with time in the two populations.

METHODS

Two cross-sectional studies were conducted in 2009-2010 (HL) and in 2015 (NHL) in survivors enrolled in European Organisation for Research and Treatment of Cancer (EORTC) Lymphoma Group and Lymphoma Study Association (LYSA) trials. The same protocol and questionnaires were used in both studies including the Multidimensional Fatigue Inventory (MFI) tool to assess fatigue and a checklist of health disorders. Multivariate linear regression models were used in the two populations separately to assess the influence of time since diagnosis and primary treatment, age, gender, education level, cohabitation status, obesity and health disorders on fatigue level changes. Fatigue level changes were compared to general population data.

RESULTS

Overall, data of 2023 HL and 1619 NHL survivors with fatigue assessment available (99 and 97% of cases, respectively) were analyzed. Crude levels of fatigue were similar in the two populations. Individuals who reported health disorders (61% of HL and 64% of NHL) displayed higher levels of fatigue than those who did not (P <  0.001). HL survivors showed increasing fatigue level with age while in NHL survivors mean fatigue level remained constant until age 70 and increased beyond. HL survivors showed fatigue changes with age higher than those of the general population with health disorders while NHL survivors were in between those of the general population with and without health disorders.

CONCLUSIONS

Among lymphoma survivors progressive increase of fatigue level with time since treatment completion is a distinctive feature of HL. Our data suggest that changes in fatigue level are unlikely to only depend on treatment complications and health disorders. Investigations should be undertaken to identify which factors including biologic mechanisms could explain why a substantial proportion of survivors develop high level of fatigue.

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

OBJECTIVE

Studies have shown that a proportion of patients with aggressive non-Hodgkin lymphoma (NHL) treated with standard chemotherapy will have long-term life expectancy comparable to those in the age-adjusted general population. This systematic literature review summarizes current literature regarding health-related quality of life (HRQoL) of long-term (≥2 years) survivors of aggressive NHL.

METHODS

Electronic databases (without restriction on years) and abstracts from four major oncology and HRQoL conferences from 2014 to 2017 were searched. Studies were included if HRQoL or health utility was assessed at least 2 years after NHL diagnosis. Studies focusing on central nervous system lymphoma, or indolent NHL, were excluded. Results were categorized relative to baseline (improvement, deterioration or no change) and compared to the general population (better, comparable or worse).

RESULTS

Fourteen studies met the inclusion criteria. Twelve studies included ≥1 HRQoL instrument, and two measured health utilities using EQ-5D. Half of the studies showed improvement (5/10) and half no change (5/10) in overall HRQoL. Compared to the general population, overall HRQoL was more comparable when assessed at ≥3 years from baseline (3/3 better or comparable) versus assessment at <3 years (2/3 better or comparable). Six studies reported on the physical HRQoL domain with improvement in 4/6 studies and no change in 2/6 studies.

CONCLUSIONS

HRQoL of NHL survivors may improve from baseline and becomes more comparable to general population HRQoL with longer survival. Overall HRQoL improvement is driven mostly by improvements in the physical domain.

Comparison of the impact of cancer between British and US long-term non-Hodgkin lymphoma survivors

PURPOSE

The aims of this study were to examine quality of life, using the Impact of Cancer version 2 (IOCv2), in British non-Hodgkin lymphoma (NHL) survivors and investigate differences between survivors in the UK and the USA.

METHODS

NHL survivors (326 UK and 667 US) completed the 37-item IOCv2 and psychological distress, fatigue and social support questionnaires.

RESULTS

The IOCv2 showed good reliability in the British sample with higher internal consistency (Cronbach alpha 0.7-0.9) and no floor and ceiling effects. UK survivors showed significantly higher negative (p < 0.001) and higher positive (p = 0.003) IOC compared to US survivors. Younger survivors (p = 0.003), those with shorter time since diagnosis (p < 0.001) and with lower levels of social support (p = 0.001), showed more negative IOC in both groups. Higher negative IOC was also significantly associated with fatigue (p < 0.001) and depressive symptoms (p < 0.001) in both countries. Higher positive IOC was associated with female gender (p < 0.001), longer time since diagnosis (p = 0.02), those diagnosed at later stage (p < 0.05) and with greater social support (p = 0.004). Whereas significantly lower positive IOC was associated with white ethnicity (p < 0.001), higher education levels (p < 0.05) and fatigue (p = 0.001).

CONCLUSIONS

The IOCv2 is reliable and applicable in UK and US populations. Both negative and positive IOC scores were higher in British compared to US survivors. However, in both countries, psychosocial factors consistently showed the greatest impact on QOL irrespective of clinical characteristics. Recognition and treatment of individuals with these risk factors is a high priority for improving QOL in long-term cancer survivors, as is the development of modular interventions aimed at increasing positive IOC as well as decreasing negative impact. The IOCv2 shows great potential both as a screening and assessment measure for examining cancer-related outcomes among survivors.

A Feasibility Study of Virtual Reality Exercise in Elderly Patients with Hematologic Malignancies Receiving Chemotherapy

OBJECTIVE

Adherence to rehabilitation exercise is much lower in patients with hematologic malignancies (22.5-45.8%) than in patients with solid tumors (60-85%) due to the administration of more intensive chemotherapeutic regimens in the former. Virtual reality exercise can be performed even in a biological clean room and it may improve the adherence rates in elderly patients with hematologic malignancies. Thus, in this pilot study, we aimed to investigate the feasibility and safety of virtual reality exercise intervention using Nintendo Wii Fit in patients with hematologic malignancies receiving chemotherapy.

METHODS

In this feasibility study, 16 hospitalized patients with hematologic malignancies aged ≥60 years performed virtual reality exercise for 20 minutes using the Nintendo Wii Fit once a day, five times a week, from the start of chemotherapy until hospital discharge. The adherence rate, safety, and physical and psychological performances were assessed.

RESULTS

The adherence rate for all 16 patients was 66.5%. Nine patients completed the virtual reality exercise intervention with 88 sessions, and the adherence rate was 62.0%. No intervention-related adverse effects >Grade 2, according to National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0, were observed. We noted maintenance of the physical performance (e.g., Barthel index, handgrip strength, knee extension strength, one-leg standing time, and the scores of timed up and go test and Instrumental Activities of Daily Living) and psychosocial performance (e.g., score of hospital anxiety and depression scale).

CONCLUSION

Virtual reality exercise using the Wii Fit may be feasible, safe and efficacious, as demonstrated in our preliminary results, for patients with hematologic malignancies receiving chemotherapy.

Volume and correlates of objectively measured physical activity and sedentary time in non-Hodgkin lymphoma survivors

OBJECTIVES

Few studies have measured the physical activity levels of non-Hodgkin lymphoma (NHL) survivors, and no previous studies have measured sedentary behavior levels in this population. This study used accelerometers to measure the physical activity and sedentary time levels of NHL survivors and examined the demographic, behavioral, and medical correlates of these behaviors.

METHODS

A total of 156 NHL survivors (mean age = 64 years) completed a questionnaire and wore an accelerometer for seven consecutive days during waking hours. Descriptive statistics were used to describe physical activity and sedentary time levels, and linear regression was used to investigate correlates of these behaviors.

RESULTS

Participants averaged 8.6 h of sedentary time per day (60% of their accelerometer wear time), 5.3 h of light-intensity physical activity (37%), and 30 min of moderate-intensity physical activity (3%). Only 12% of the participants accrued the duration of moderate-vigorous physical activity recommended by physical activity guidelines (30 min accrued in bouts of at least 10 min). Female participants, older participants, smokers, and participants with larger waist circumference had lower levels of moderate-to-vigorous intensity physical activity. Smokers and participants with larger waist circumference also had higher sedentary time levels.

CONCLUSION

The NHL survivors in this study spent the majority of their waking hours sedentary, and few met physical activity guidelines. The results of this study emphasize the need for more research exploring the health consequences of sedentary behavior and physical inactivity in NHL survivors. Copyright © 2015 John Wiley & Sons, Ltd.

Validation of the PROMIS physical function measures in a diverse US population-based cohort of cancer patients

PURPOSE

To evaluate the validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function measures in a diverse, population-based cancer sample.

METHODS

Cancer patients 6-13 months post-diagnosis (n = 4840) were recruited for the Measuring Your Health study. Participants were diagnosed between 2010 and 2013 with non-Hodgkin lymphoma or cancers of the colorectum, lung, breast, uterus, cervix, or prostate. Four PROMIS physical function short forms (4a, 6b, 10a, and 16) were evaluated for validity and reliability across age and race-ethnicity groups. Covariates included gender, marital status, education level, cancer site and stage, comorbidities, and functional status.

RESULTS

PROMIS physical function short forms showed high internal consistency (Cronbach's α = 0.92-0.96), convergent validity (fatigue, pain interference, FACT physical well-being all r ≥ 0.68), and discriminant validity (unrelated domains all r ≤ 0.3) across survey short forms, age, and race-ethnicity. Known-group differences by demographic, clinical, and functional characteristics performed as hypothesized. Ceiling effects for higher-functioning individuals were identified on most forms.

CONCLUSIONS

This study provides strong evidence that PROMIS physical function measures are valid and reliable in multiple race-ethnicity and age groups. Researchers selecting specific PROMIS short forms should consider the degree of functional disability in their patient population to ensure that length and content are tailored to limit response burden.

[Neurotoxic the effects of chemotherapy on the function of the central nervous system in children with lymphoid tumors]

INTRODUCTION

In children with lymphoid tumors (LT) chemotherapy is the main treatment. It is known, that many chemotherapy drugs have toxic effects on the central nervous system and is a factor, that leads to significant cognitive impairment. Purpose: Search of neurophysiological, neurochemical, and psychological correlates of neurotoxicity in children with LT when programmed therapy.

MATERIAL AND METHODS

The study included 39 children (4-16 years) with LT, with acute lymphoblastic leukemia (ALL) - 25, with non-Hodgkin's lymphoma (NHL) - 14 who were treated according to the scheme m-BFM-90: for patients with ALL (mALL-BFM -90) and the NHL (mNHL - BFM-90). Investigated the EEG, REG, ECHO EG. In 12 children with LT in blood serum levels of middle molecules (MM) - indicator of general toxicity, N-acetylneuraminic acid (N-ANA) - indicator of neurotoxicity, malondialdehyde (MDA) - lipid peroxidation, tocopherol, retinol - indicators of antioxidant protection, level of catalase - as free radical oxida- lion; vanilmindalic acid levels (VMA) - as indicator of the state catecholaminergic system. Studies were performed before treatment, after induction of remission, after M-protocol, after the end of chemotherapy. In 23 children (11-16 years) with LT during chemotherapy, performed a comparison of EEG and the level of anxiety (Ch.D.Spilberger), <<strategy selection behavior>> (Thomas-Kilman). Control group - healthy children of the same age.

RESULTS

The main results obtained in the present study were that 1) Prior to initiation of treatment of children with LT had a EEG changes, indicating certain dysfunction of diencephalic structures of the brain, and probably due to metabolic disorders that affect the neurotransmitter metabolism. 2) Toxic effects of chemotherapy on the CNS program was shown on a range of indicators: according to EEC-increasing values of relative power in the band δ- and Θ-frequency range, lower α-activity, increase of relative power in the band betal,2; according to REG-hemodynamic compromise; increasing levels of neurochemical indicators N-ANA and the VMA. This was accompanied by behavior strategies <<adaptation>> and <<cooperation>>, are not peculiar to healthy peers. Identified individual predictors of neurotoxicity in the software of chemotherapy in children with LT.

Yoga in addition to standard care for patients with haematological malignancies

BACKGROUND

Haematological malignancies are malignant neoplasms of the myeloid or lymphatic cell lines including leukaemia, lymphoma and myeloma. In order to manage physical and psychological aspects of the disease and its treatment, complementary therapies like yoga are coming increasingly into focus. However, the effectiveness of yoga practice for people suffering from haematological malignancies remains unclear.

OBJECTIVES

To assess the effects of yoga practice in addition to standard cancer treatment for people with haematological malignancies.

SEARCH METHODS

Our search strategy included the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 to 4th February 2014), databases of ongoing trials (controlled-trials.com; clinicaltrials.gov), conference proceedings of the American Society of Clinical Oncology, the American Society of Hematology, the European Haematology Association, the European Congress for Integrative Medicine, and Global Advances in Health and Medicine. We handsearched references of these studies from identified trials and relevant review articles. Two review authors independently screened the search results.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of yoga in addition to standard care for haematological malignancies compared with standard care only. We did not restrict this to any specific style of yoga.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data for eligible studies and assessed the risk of bias according to predefined criteria. We evaluated distress, fatigue, anxiety, depression and quality of sleep. Further outcomes we planned to assess were health-related quality of life (HRQoL), overall survival (OS) and adverse events (AE), but data on these were not available.

MAIN RESULTS

Our search strategies led to 149 potentially relevant references, but only a single small study met our inclusion criteria. The included study was published as a full text article and investigated the feasibility and effect of Tibetan Yoga additional to standard care (N = 20; 1 person dropped out before attending any classes and no data were collected) compared to standard care only (N = 19). The study included people with all stages of Hodgkin and non-Hodgkin's lymphoma, with and without current cancer treatment. The mean age was 51 years.We judged the overall risk of bias as high as we found a high risk for performance, detection and attrition bias. Additionally, potential outcome reporting bias could not be completely ruled out. Following the recommendations of GRADE, we judged the overall quality of the body of evidence for all predefined outcomes as 'very low', due to the methodical limitations and the very small sample size.The influence of yoga on HRQoL and OS was not reported. There is no evidence that yoga in addition to standard care compared with standard care only can improve distress in people with haematological malignancies (mean difference (MD) -0.30, 95% confidence interval (CI) -5.55 to 4.95; P = 0.91). Similarly, there is no evidence of a difference between either group for fatigue (MD 0.00, 95% CI -0.94 to 0.94; P = 1.00), anxiety (MD 0.30, 95% CI -5.01 to 5.61; P = 0.91) or depression (MD -0.70, 95% CI -3.21 to 1.81; P = 0.58).There is very low quality evidence that yoga improves the overall quality of sleep (MD -2.30, 95% CI -3.78 to -0.82; P = 0.002). The yoga groups' total score for the Pittsburgh Sleep Quality Index (PSQI) was 5.8 (± 2.3 SD) and better than the total score (8.1 (± 2.4 SD)) of the control group. A PSQI total score of 0 to 5 indicates good sleep whereas PSQI total score 6 to 21 points towards significant sleep disturbances. The occurrence of AEs was not reported.

AUTHORS' CONCLUSIONS

The currently available data provide little information about the effectiveness of yoga interventions for people suffering from haematological malignancies. The finding that yoga may be beneficial for the patients' quality of sleep is based on a very small body of evidence. Therefore, the role of yoga as an additional therapy for haematological malignancies remains unclear. Further high-quality randomised controlled trials with larger numbers of participants are needed to make a definitive statement.

Is there a relationship between posttraumatic stress and growth after a lymphoma diagnosis?

OBJECTIVE

There are conflicting empirical data regarding the relationship between posttraumatic stress (PTS) and growth (PTG) observed in cancer survivors. Clarification of this association could inform evidence-based therapeutic recommendations to promote adjustment in survivors following a cancer diagnosis.

METHODS

This cross-sectional study employed standardized measures to examine the association between PTS and PTG in a sample of long-term lymphoma survivors. In addition, associations between PTG and demographic, clinical and psychosocial variables were identified to inform clinical recommendations.

RESULTS

Long-term survivors of non-Hodgkin lymphoma provided informed consent (n = 886; 74% response rate). Subjects averaged 10.2 years post-diagnosis and 62.9 years of age. No significant association was found between the PTS and PTG summary scores. Several demographic and clinical variables (e.g., female gender and greater social support) were independently associated with greater PTG.

CONCLUSIONS

Clinicians are advised to be attentive to psychosocial needs throughout the post-cancer diagnosis adjustment period by screening for PTS symptomatology and recognizing that survivors who report growth may also be highly distressed.

[Adjustment disorders in children, first hospitalized for hematological malignancies]

OBJECTIVE

In the structure of oncological diseases of childhood, blood diseases occupy a leading position (40%). According to some researchers, the prevalence of mental disorders among patients with oncohematological pathology is very high, regardless of the age of patients. The aim of this work was to identify clinical/dynamic and typological characteristics of mental disorders in children with hematological malignancies as well as the factors predisposing to these disorders.

MATERIAL AND METHODS

The study involved 96 children (63 boys and 33 girls), aged 3-12 years, with hematological malignancies (acute lymphoblastic leukemia, acute myeloid leukemia, Hodgkin's lymphoma, non-Hodgkin's lymphoma).

RESULTS AND CONCLUSION

Mental disorders were presented with a wide range of violations, including the endogenous pathology (8 children), a mild degree of mental retardation (n=2), adjustment disorders (n=86). Adjustment (adaptation) disorders included an diety, phobic and depressive reactions. The appearance, form and severity of disorders were influenced by a range of factors, which had a different contribution to the process. Family history, premorbid personality traits, interpersonal relationships within the family and the type of education seem to be less important compared to the age of the patients that determined the preferred range of disorders, forming the leading psichogenic symptoms.

[The "Fragebogen zur sozialen Integration (FSI)" - psychometric properties and acceptance in patients with hematological malignancies]

OBJECTIVES

The "Fragebogen zur Sozialen Integration (FSI)" is the German adaption of the "Social Adjustment Scale (SAS-SR)". So far, there is no validation of the FSI with regard to patients with cancer.

METHODS

The scales leisure time, relatives and partnership of the FSI were test-statistically analyzed in hemato-oncological patients. Concordant validity was examined referring to the German version of the "Social Support Questionnaire (F-Sozu)" and one scale of the "EORTC QLQ-C30".

RESULTS

In N = 184 participants, we observed in 1% - 20% missing values for several items. Ceiling effects could be observed for the scales relatives (1.22-2.20), whereby for the scales leisure time (1.27-2.95) and partnership (1.51-3.91) the range was substantially higher. Internal consistency averaged about 0.75 (leisure time, partnership), respectively, 0.69 (relatives). Analyses for validity showed values of -0.23 to -0.50 (F-Sozu) as well as -0.29 to -0.40 (EORTC QLQ-C30), respectively.

CONCLUSION

The FSI is a reliable questionnaire to assess social adjustment within hemato-oncological cancer patients. However, psychometric properties in previous studies with psychosomatic patients were better. The high amount of missing values on several items in our study suggests a partial revision of the this instrument would be advisable for use in oncology.

Quality of life among long-term survivors of non-Hodgkin lymphoma: a follow-up study

PURPOSE

Little is known about change in quality of life (QOL) among long-term cancer survivors. We examined change over time in QOL among long-term survivors of non-Hodgkin lymphoma and identified demographic, clinical, and psychosocial risk factors for poor outcomes.

METHODS

Surveys were mailed to 682 lymphoma survivors who participated in a study 5 years earlier, when on average they were 10.4 years postdiagnosis. Standardized measures of QOL, perceptions of the impact of cancer, symptoms, medical history, and demographic variables were reported at both time points and examined using linear regression modeling to identify predictors of QOL over time.

RESULTS

A total of 566 individuals participated (83% response rate) who were a mean of 15.3 years postdiagnosis; 52% were women, and 87% were white. One third of participants (32%) reported persistently high or improved QOL, yet a notable proportion (42%) reported persistently low or worsening QOL since the earlier survey. Participants who received only biologic systemic therapy reported improvement in physical health despite the passage of time. Older age, more comorbidity, and more or increasing negative and decreasing positive perceptions of cancer's impact were independent predictors of poor QOL. Lymphoma symptom burden, less social support, and having received a transplantation were related to negative perceptions of cancer's impact.

CONCLUSION

Moderate to severe symptom burden, limited social support, or having received a transplantation should alert the clinician to potential need for supportive services. Perceptions of cancer's impact are associated with QOL cross-sectionally and longitudinally; modifying these perceptions may thus provide a strategy for improving QOL.

Hope against hope in cancer at the end of life

Hope has many facets to it in the context of cancer. This article outlines an instrumental case study for a patient with aggressive lymphoma who rapidly deteriorated to the point of dying. How her and her family's hope was managed is outlined here from various perspectives. Interviews were carried out with the patient's family, medical consultant-in-charge (attending physician) and nurses caring for her at the end of life. The findings outline the transition from hope for cure to hope for a good death and the role that the patient and family's Christian hope played in this. Religiosity and spirituality of hope in terms of Christian hope is explored from the theological perspective. Practical aspects of care in the face of changing hope are discussed. Conclusions are drawn about reframing hope in a changing clinical situation with reference to theories of hope. The importance of acknowledging hope, coping, spirituality and religiosity, especially at end of life, is emphasised.

[Evaluation of health-related quality of life in patients with non-Hodgkin lymphoma and colorectal cancer at different stages, attending the Mexican Institute of Social Security]

INTRODUCTION

In Mexico during 2008, were reported 127,604 new cancer cases, 6,347 of them were colorectal cancer cases and 4,276 non-Hodgkin lymphoma (NHL) cases.

OBJECTIVE

To evaluate health related quality of life in non-Hodgkin lymphoma and colorectal cancer cases in different clinical stages, attended in a High Specialty Medical facility at the Instituto Mexicano del Seguro Social, during a 13 month period.

RESULTS

162 patients were included, 56.8% (n=92) with NHL and 43.2% (n=70) with colorectal cancer. The scores obtained in the NHL group were: Global health status/QoL: 67.75 (± 27.55), physical functioning 69.64 (± 29.98), role functioning 71.38 (± 33.73), emotional functioning 69.7 (± 26.57), cognitive functioning 75.36 (± 28.01), social functioning 79.35 (± 29.38), fatigue 35.27 (± 28.27), nausea and vomiting 13.41 (± 21.85), pain 28.08 (± 30.25), dyspnea 19.20 (± 32.11), insomnia 30.80 (± 38.03), appetite lost 26.45 (± 36.16), constipation 19.20 (± 32.11), diarrhea 12.32 (± 26.48), financial difficulties 26.09 (± 35.57). In colorectal cancer patients the scores were: Global health status/QoL: 68.21 (± 24.46), physical functioning 67.38 (± 30.45), role functioning 65.48 (± 35.70), emotional functioning 66.43 (± 26.84), cognitive functioning 78.57 (± 26.49), social functioning 75.24 (± 31.05), fatigue 37.78 (± 31.62), nausea and vomiting 20.00 (± 28.32), pain 37.38 (± 34.45), dyspnea 11.90 (± 26.64), insomnia 28.09 (± 35.73), appetite lost 23.81 (± 36.40), constipation 19.05 (± 32.88), diarrhea 20.95 (± 31.17), financial difficulties 34.76 (± 38.67).

CONCLUSIONS

With these basal results is important a follow-up with special attention to the treatment and attendance processes, in patients with this neoplasms and their impact on the quality of life.

An exploratory model of the relationships between cancer-related trauma outcomes on quality of life in non-Hodgkin lymphoma survivors

Given that more than one third of some cohorts of cancer survivors exhibit post-traumatic stress disorder (PTSD) symptomatology, this study examines how trauma outcomes might relate to quality of life (QOL). Eight hundred thirty survivors of adult lymphoma were assessed for PTSD, post-traumatic growth (PTG) and QOL. Structural equation modeling revealed that QOL was best explained by the model in which stressors (e.g., co-morbidities) were mediated by PTSD and PTG. Trauma outcomes mediated the relationship between specific stressors and QOL. These findings support using PTSD and PTG as a diagnostic framework in understanding symptomatology in survivors.

Post-traumatic Stress Disorder and Quality of Life in Long-term Survivors of Hodgkin's Disease and Non-Hodgkin's Lymphoma in Israel

Post-traumatic stress disorder (PTSD) has not been examined systematically in long-term survivors of lymphoma. In this study, PTSD and health related quality of life (HRQoL) were assessed in 44 patients with Hodgkin's disease (n = 8) or non-Hodgkin's lymphoma (n = 36). Forty-four individuals who had experienced traumatic events as defined by the Diagnostic and Statistical Manual-IV (DSM-IV) as possible triggers for PTSD served as controls. The study participants were administered two questionnaires-the PTSD inventory scale and the Short Form-36 (SF-36) HRQoL instrument measuring physical and mental HRQoL. Full PTSD was defined as meeting the DSM-IV criteria for the diagnosis in all three symptom groups measured on the PTSD inventory scale-intrusion, avoidance and hyper-arousal and partial PTSD as meeting the diagnostic criteria in two of the symptom groups. There was a significant increase in the hyper-arousal scale in the lymphoma survivor group (F 5, P < 0.05). Overall, full or partial PTSD was found in 14 lymphoma survivors (32%) and in 11 individuals (25%) in the control group (difference not significant). Survivors whose disease had started at an earlier age suffered significantly more intensive intrusion and avoidance symptoms. The lymphoma survivor group had a significantly lower physical HRQoL than the control group independent of PTSD symptoms. In both groups, the presence of PTSD symptoms correlated with a lower HRQoL. These results suggest that lymphoma is a trauma similar to other more accepted definitions of trauma which can lead to PTSD, and is associated with more severe hyper-arousal symptoms. Psychological interventions in the early stages of treatment or follow-up may help reduce the morbidity from PTSD and improve quality of life.

Pre-transplant depression as risk factor for survival of patients undergoing allogeneic haematopoietic stem cell transplantation

INTRODUCTION

Depression is discussed as a possible risk factor for survival in cancer patients. We explored this relationship for patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT).

PATIENTS AND METHODS

The depression subscale of the Hospital Anxiety and Depression Scale (HADS) served as a measure for depression. One hundred and thirty-eight patients (mean age 41 years; different diagnoses) participating in a psycho-oncology study filled in the HADS after admission for allogeneic HSCT. They were followed-up for at least two years; 72 patients died during follow-up.

RESULTS

Depression scores were not correlated with medical and psychosocial objective factors with the exception of having under-aged children. Controlling for medical factors that showed up as predictors for survival in our sample (patient's age at HSCT, having had a transplant before, risk for treatment failure) the HADS depression score (range 0-21) emerged as an independent predictor (Cox regression): hazard ratio = 1.087, 95% CI = 1.018-1.161.

CONCLUSION

Depression is probably not a simple indicator of a worse health status. Further research is needed to decide if depression must be considered as an independent risk factor for survival when diagnosed in the pre-transplant period.

Quality of life before and one year following stem cell transplantation using an individualized and a standardized instrument

OBJECTIVE

The aim was to prospectively measure quality of life in patients with malignant blood disorders following stem cell transplantation (SCT) using an individualized and a standardized measure.

METHODS

Twenty-two consecutive patients were assessed before and one year following SCT, using a generic and disease-related version of the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW) and the EORTC QLQ-C30. Results of the QLQ-C30 were compared with Swedish norm values.

RESULTS

A majority of the patients reported concerns related to health before as well as one year after SCT, recorded by both instruments. Mean scores produced by the SEIQoL-DW, and four scales of the EORTC QLQ-C30, showed a change over time, indicating improved quality of life one year after SCT. In comparison with Swedish norm values for the EORTC QLQ-C30, SCT recipients reported a worse functioning.

CONCLUSIONS

In addition to well-known disease and treatment-related problems, areas not typically included in standardized instruments were nominated in the disease-related SEIQoL-DW. Such areas included positive aspects, e.g. a changed view of life and oneself. The results support the use of the generic and disease-related SEIQoL-DW to achieve a comprehensive picture of patient's clinical situation under treatment or when recovering from illness.

Psychosocial, health and demographic characteristics of quality of life among patients with acute myeloid leukemia and malignant lymphoma who underwent autologous hematopoietic stem cell transplantation

CONTEXT AND OBJECTIVE

This study evaluated the effect of selected psychosocial, health and demographic characteristics of quality of life (QOL) among patients treated with autologous hematopoietic stem cell transplantation (HSCT).

DESIGN AND SETTING

This was a retrospective study at Charles University Hospital, Hradec Kralove.

METHODS

The Czech version of the international generic European Quality-of-Life questionnaire (EQ-5D) was applied to evaluate QOL among patients with acute myeloid leukemia (AML) and malignant Hodgkins and non-Hodgkins lymphoma (ML). The total number of respondents was 36: 12 with AML (seven males and five females) and 24 with ML (11 males and 13 females). The mean age of AML respondents was 46 years and the mean age of ML respondents was 44.5 years.

RESULTS

Age, smoking status and education level had statistically significant effects on QOL among AML respondents (p < 0.05), and age had a statistically significant effect on QOL among ML respondents (p < 0.05). The overall QOL among AML and ML respondents was generally good: the mean EQ-5D score among AML respondents was 71.5% and among ML respondents it was 82.7%.

CONCLUSION

The QOL among AML and ML respondents treated with autologous HSCT was good. However, patients more than 50 years old, smokers and patients with lower education levels presented worse QOL. These findings need to be better evaluated in longitudinal studies, using large samples.

Music imagery for adults with acute leukemia in protective environments: a feasibility study

BACKGROUND

Patients receiving intensive chemotherapy can experience increased distressed related to both the cancer diagnosis and treatment isolation. If not addressed, distress can lead to anxiety, depression, and post-traumatic stress disorder. The purpose of this study was to determine the feasibility and possible benefits of a music imagery intervention for patients hospitalized in a protective environment for the treatment of acute leukemia or high-grade non-Hodgkin's lymphoma.

MATERIALS AND METHODS

Adults receiving intensive myelosuppressive chemotherapy in a protective environment were randomized to standard care or standard care plus music imagery. The music imagery sessions occurred twice weekly for up to eight sessions. Patients were encouraged to use the music imagery daily.

RESULTS

The principal criteria of feasibility were rate of consent, rate of completion of scheduled sessions, and rate of questionnaire completion. Forty-nine out of 78 patients consented, a 63% consent rate. Seventy-two percent of all scheduled music imagery sessions were completed. The rate of questionnaire completion was 60% with missing data because of illness severity and early discharge. The principal outcomes of benefit (e.g., efficacy) were positive and negative affects, fatigue, and anxiety. Both groups improved over time on all outcomes (all p < 0.001). However, a subgroup of individuals with low baseline negative affect who received the intervention reported significantly less anxiety at discharge than individuals with low baseline negative affect who did not receive the intervention.

CONCLUSIONS

Music imagery is feasible for adults with acute leukemia in protected environments. Patients with lower initial distress may benefit from a music imagery program in terms of reduced anxiety at discharge.

Quality-of-life in elderly patients with cancer: a short review

BACKGROUND

Prolongation of survival and maintenance or improvement of health-related quality-of-life (HRQoL) are the two important goals within the treatment of individual patients. Due to the severity of symptoms and the toxicity of treatment, HRQoL has become a major area of concern when treating cancer patients in general and elderly patients in particular.

PATIENTS AND METHODS

We present a literature review of HRQoL aspects in elderly patients with cancer and especially address the topic whether impairments in the different tools of a comprehensive geriatric assessment (CGA) are associated with decreased HRQoL in elderly cancer patients.

RESULTS

Elderly cancer patients tend to weight their HRQoL as more important than gain in survival, when compared to younger patients. An age-dependent decrease in different scales of HRQoL is reported in patients and normative samples. HRQoL is also a predictor of survival. The variation of HRQoL can be used in trials comparing different treatment options. In individual patients, regular measurement of HRQoL aims to improve patients-centred care. Age related impairments of different areas of CGA are associated with decreased HRQoL in elderly cancer patients.

CONCLUSIONS

HRQoL is an important outcome with elderly cancer patients and should be assessed regularly and thoroughly.

Symptom burden in patients undergoing autologous stem-cell transplantation

Patients who undergo autologous peripheral blood stem cell (PBSC) transplantation experience multiple symptoms that adversely affect quality of life. We assessed symptoms during the acute phase of autologous PBSC transplantation to determine the severity of individual symptoms and to determine overall symptom profiles in 100 patients with multiple myeloma or non-Hodgkin's lymphoma. Study subjects completed the blood and marrow transplantation module of the M. D. Anderson Symptom Inventory before hospitalization, during conditioning, on day of transplantation, at nadir (the time of lowest white blood cell count) and on day 30 post-transplantation. Additional symptom, quality-of-life and medical status measures were collected. Symptom means were mild at baseline, intensified during conditioning, peaked at nadir and decreased by day 30. At nadir, the most severe symptoms for the entire patient sample were lack of appetite, fatigue, weakness, feeling sick, disturbed sleep, nausea and diarrhea. Cancer diagnosis was a significant predictor of changes in symptoms over time. The patterns of fatigue, pain, sleep disturbance and lack of appetite were significantly different for patients with multiple myeloma as compared with patients with non-Hodgkin's lymphoma.

Quality of life among long-term non-Hodgkin lymphoma survivors

BACKGROUND

The objective of this population-based study was to document the long-term effects (5-15 years postdiagnosis) of non-Hodgkin lymphoma and its treatment on health-related quality of life (HRQL) and social problems.

METHODS

The population-based Eindhoven Cancer Registry was used to select all patients who were diagnosed with non-Hodgkin lymphoma from 1989 to 1998. Three hundred sixty patients were invited to complete the 36-item Short Form Health Survey (SF-36) and the Quality of Life-Cancer Survivors questionnaire, and 294 patients (82%) responded.

RESULTS

Patients who had received chemotherapy reported significantly worse psychological and social well-being and health-related quality of life (HRQL) than patients who had not received chemotherapy. Radiotherapy and watchful waiting were not associated significantly with HRQL outcomes. Patients who were diagnosed from 10 to 15 years earlier reported better social well-being than patients who were diagnosed from 5 to 9 years earlier. Compared with an age-matched, normative sample from the general population, patients reported significantly worse general health and less vitality, but they reported less bodily pain. Practical problems were reported with work (41%), obtaining health care insurance (6%) and life insurance (15%), and obtaining a home mortgage (22%).

CONCLUSIONS

From 5 to 15 years after diagnosis, the general health perceptions and vitality levels of non-Hodgkin lymphoma survivors remained significantly lower than those of their peers in the of general population. In addition, survivors faced practical problems with work and finances that deserve additional attention during the period of rehabilitation.

Validation of the Distress Thermometer with bone marrow transplant patients

The Distress Thermometer (DT) is a one-item screening measure of psychological distress in cancer patients. This study examines the operating characteristics of the DT in patients about to undergo bone marrow transplant (BMT). Patients (N=491) completed the DT, the Center for Epidemiological Studies-Depression Scale (CES-D), the State-Trait Anxiety Inventory-State Version (STAI-S), the ECOG Performance Status Scale, and the Patient Problem List. DT scores were related to higher depression, higher anxiety, and poorer performance status. Receiver operating characteristic (ROC) curve analyses of DT scores yielded area under the curve estimates of 0.75 when compared to the CES-D cutoff score of 16, suggesting the DT has acceptable overall accuracy. The DT cutoff score of 4 had the greatest sensitivity and specificity when compared to the CES-D cutoff score. Patients above this cutoff score reported worse ECOG scores and more practical, family, emotional, and physical problems (all p's< or =0.05) than those below the cutoff. The findings suggest the DT is a useful tool for screening for distress in BMT patients. The optimal DT cutoff score of 4 found here was identical to that found in another study using different criteria. This cutoff score also identified patients with problems likely to reflect psychological distress.

Quality of life after total or partial gastrectomy for primary gastric lymphoma

Up to 90% of patients with localized non-Hodgkin's lymphomas (NHL) in the gastrointestinal tract (GI) are cured and decreased use of radical surgery is favoured. Although quality of life (QOL) may impact treatment choice, little is known about QOL in gastric NHL survivors. The self-reported QOL (EORTC QLQ-C30 and a gastric module) and objective findings from upper GI endoscopy were evaluated in patients in complete remission after treatment for primary gastric NHL at the Norwegian Radium Hospital (NRH). Thirty-six (90%) patients completed the questionnaires, 33 (83%) met for endoscopy. Ten patients were treated with total gastrectomy, 17 with partial gastrectomy, while nine patients did not undergo surgery. Gastroscopy was normal in 55% of the non-gastrectomised patients, oesophagoscopy in 69%. Four patients had Barrett's metaplasia. QOL was not different from population values. Patients treated with total gastrectomy reported poorer emotional function, more diarrhoea and more food-related problems (p< or =0.05) compared with the others. Based on the higher level of digestive and food related problems after total gastrectomy, stomach-preserving surgery should be preferred whenever possible.

Exercise preferences among a population-based sample of non-Hodgkin's lymphoma survivors

In the present study, we examined the exercise preferences of a population-based sample of non-Hodgkin's lymphoma (NHL) survivors. A secondary purpose was to explore the association between various demographic, medical, and exercise behaviour variables and elicited exercise preferences. Using a retrospective survey design, 431 NHL survivors residing in Alberta, Canada completed a mailed questionnaire designed to assess exercise preferences, past exercise behaviour, and various demographic variables. Overall, 77% of participants preferred or maybe preferred to receive exercise counselling at some point after their NHL diagnosis. An overwhelming majority indicated that they would possibly be interested (81%) and able (85%) to participate in an exercise programme designed for NHL survivors. The majority of participants (55%) listed walking as their preferred choice of exercise. Logistic regression analyses indicated that NHL survivors' exercise preferences were influenced by body mass index (BMI), exercise behaviour, and gender. Eliciting exercise preferences from the population in question yields important information for cancer care professionals designing exercise programmes for NHL survivors. Furthermore, tailoring exercise programmes to the preferences of NHL survivors may be one method to potentially enhance exercise adherence in this population both inside and outside of clinical trials.

An evaluation of age-related differences in quality of life preferences in patients with non-Hodgkin's lymphoma

Health related quality of life is an important outcome measure. With aging, patients may experience changes in physical, socioeconomic and psychological functioning. This pilot study examined whether age influences the level of importance that patients with non-Hodgkin's lymphoma assign to questions addressing aspects of traditional quality of life domains. A questionnaire assessing six domains (physical, appearance, toxicity, social, financial, psychological) with 29 items was given to 76 outpatients with non-Hodgkin's lymphoma. Each question asked how important the content of the item was to the individual. Mean item scores were compared between patients aged < 65 and > 65 years. Reliability ranged from 0.57 (social domain) to 0.83 (physical domain). Test-retest reliability for the entire questionnaire was 0.63. Although there was a suggestion that older patients scored the items relating to faith, appearance to others, intimacy and toxicity trade-offs differently than younger patients, when accounting for multiple comparisons in this study, no apparent differences were seen in any of the items between age groups. It appears that in this group of patients with lymphoma, age does not obviously influence the preferences of patients for items contained in quality of life assessment.

Differences in quality of life between non-Hodgkin's lymphoma survivors meeting and not meeting public health exercise guidelines

The primary purpose of this study was to examine differences in quality of life (QoL) between non-Hodgkin's lymphoma (NHL) survivors meeting and not meeting public health exercise guidelines. A secondary purpose was to examine exercise behavior changes across three distinct cancer-related time periods (i.e. prediagnosis, on treatment and off treatment). Using a retrospective survey design, 438 NHL survivors residing in Alberta, Canada completed a mailed questionnaire that assessed self-reported exercise prediagnosis, on treatment and off treatment, and current QoL. Descriptive analyses indicated that 33.8, 6.5 and 23.7% of NHL survivors met public health exercise guidelines during prediagnosis, on treatment, and off treatment time periods, respectively. Multivariate analyses of variance indicated that NHL survivors meeting public health exercise guidelines during postdiagnosis time periods had higher current QoL scores than NHL survivors not meeting guidelines. QoL difference scores between the two groups met proposed standards for clinically important differences. Multivariate analyses also indicated significant differences in exercise behavior across the three cancer-related time periods (all p's<0.01). These analyses were unchanged after statistically controlling for important medical and demographic variables. The results of this study provide evidence that NHL survivors meeting public health exercise guidelines on and off treatment reported higher current QoL than those survivors not meeting guidelines. These findings corroborate research examining exercise behavior in other cancer survivor groups and provide preliminary data to support a randomized controlled trial on exercise and QoL in this population.

Is perceived social support a predictor of survival for patients undergoing autologous peripheral blood stem cell transplantation?

PURPOSE

Previous research discussed the predictive value of psychosocial variables along with biomedical predictors for survival; such as affective functioning and quality of life. The present study addresses the following research question: does perceived social support prior to PSBCT have an impact on post-transplant survival?

SUBJECTS AND METHODS

Ninety-nine patients suffering from Multiple Myeloma (n=55), Non-Hodgkin Lymphoma (n=33), and other malignancies (n=11) completed the Illness Specific Scales of Social Support (ISSS) before undergoing PBSCT. ISSS is comprised of the subscales 'positive social support' and 'problematic social support', e.g. criticising, victimising, or avoiding interactions.

RESULTS

The mean score in the subscale 'positive social support' was 3.2 (S.D. 0.54; range 0 until 4), in the subscale 'negative social support' 0.94 (S.D. 0.53). There was no association between positive interactions and survival following PBSCT. Conversely, those patients perceiving problematic social support, showed a correspondence with poor survival following PBSCT (RR=3.649; p=0.015; Cox-regression analysis). The following variables were controlled: Karnofsky Performance Status, interferon treatment, depression and participation in psychotherapy.

CONCLUSION

Differentiating between positive and problematic interactions prior to PBSCT helps to recognise detrimental forms of social support. Future research should investigate the clinical implications and help tailor psychotherapeutic intervention.

Fatigue and depression in patients with lymphoma undergoing autologous peripheral blood stem cell transplantation

PURPOSE/OBJECTIVES

To describe the patterns of depression and fatigue, including its dimensions, and the relationship between these two variables in patients with lymphoma undergoing autologous peripheral blood stem cell transplantation (PBSCT).

DESIGN

Prospective, descriptive, correlational, repeated measures.

SETTING

Midwestern university National Cancer Institute-designated clinical cancer center.

SAMPLE

27 patients with lymphoma aged 19 to 71 undergoing autologous PBSCT.

METHODS

The revised Piper Fatigue Scale was used to measure fatigue and its dimensions. The Center for Epidemiologic Studies' Depression Scale was used to measure depression on selected days at baseline and during chemotherapy and recovery.

MAIN RESEARCH VARIABLES

Fatigue and its four dimensions (behavioral/severity, sensory, cognitive/mood, and affective meaning) and depression.

FINDINGS

Total fatigue, fatigues four dimension scores, and depression scores changed significantly over time, with the highest scores at day + 7 after transplant. Total fatigue and the four dimension scores were highly and positively correlated with depression, with the highest correlation reported between the affective fatigue dimension and depression.

CONCLUSIONS

The findings support the importance of assessing fatigue and depression in patients undergoing autologous PBSCT at baseline, during chemotherapy, and throughout recovery.

IMPLICATIONS FOR NURSING

Routine clinical assessment with close observation around day +7 after transplant and patient education about the patterns of fatigue and depression will help the healthcare team to intervene at the appropriate time and may help patients to better manage these symptoms.

Brief report: empathy and psychological adjustment in siblings of children with cancer

OBJECTIVE

To examine relationships between empathy, illness concepts, sibling relationship variables, and psychological adjustment among siblings of children with cancer.

METHODS

Participants were 29 siblings and 14 children diagnosed with acute lymphoblastic leukemia, acute myelocytic leukemia, or non-Hodgkin's lymphoma. Data included self- and parent-report questionnaires completed during active treatment.

RESULTS

Siblings did not exhibit increased rates of behavior problems, but did display more social and academic difficulties. Empathy was a significant predictor of externalizing and total problems. Cancer knowledge was not related to adjustment, but was associated with empathy. Birth order of the child with cancer and closeness within the sibling relationship were associated with less positive adjustment.

CONCLUSIONS

Empathy may play an important role in sibling adjustment following the diagnosis of cancer. Specific sibling relationship and family variables may be helpful in identifying siblings who are at greater need for psychosocial intervention.

Quality of life assessment in elderly patients with aggressive non-Hodgkin's Lymphoma treated with anthracycline-containing regimens. Report of a prospective study by the Intergruppo Italiano Linfomi

BACKGROUND AND OBJECTIVES

The aim of this study was to evaluate quality of life (QOL) in a group of elderly patients (> 65 years) with aggressive non-Hodgkin's lymphoma (NHL) treated with chemotherapy regimens containing anthracyclines.

DESIGN AND METHODS

QOL was evaluated in a population of elderly patients with aggressive NHL enrolled in a phase III clinical trial run by the Intergruppo Italiano Linfomi (IIL) from 1996 to 1999 to compare two different anthracycline-containing regimens (mini-CEOP vs P-VEBEC). The EORTC-QLQ-C30 questionnaire, which has already been validated in oncology, was used. The questionnaire was administered at the time of diagnosis, half way through the chemotherapy and at the time of restaging.

RESULTS

Ninety-one patients completed pre-therapy and post-therapy questionnaires and they are the subject of this report. Baseline QOL assessment showed a strong correlation of poor values of QOL with anemia and high risk according to the International Prognostic Index (IPI). At the end of treatment no functional scales showed worse values. A significant improvement was observed for pain (p=0.003), appetite (p=0.006), sleep (p=0.015) and global health (p=0.027). Considering only the 50 patients who achieved a complete remission (CR), an improvement was also recorded for emotional state (p=0.10), role (p=0.05), constipation (p=0.04) and global QOL (p=0.05).

INTERPRETATION AND CONCLUSIONS

The EORTC-QLQ-C30 is feasible even in a population of elderly patients, in whom it had never been tested before. The improvement of QOL at the end of the treatment demonstrated that the symptoms of the disease have a greater negative influence on the patient's life than do the side effects of the therapy.

Are we making progress? Not in haematology!

It will be shown, through the presentation of recent research findings, that haematology is a neglected area in terms of sensitive care of the dying. The Australian evidence indicates that scant progress has been made in relation to even the most basic palliative care practices such as sensitive, honest information giving or appropriate referral to the palliative system. Rather, the data show that during terminal trajectory, patients from these diagnostic groups and their families remain trapped in processes within the high-tech, curative system that are not responsive to the needs of the dying.

Cognitive functions in survivors of primary central nervous system lymphoma

BACKGROUND

The standard treatment for primary CNS lymphoma (PCNSL) involves high-dose methotrexate-based (MTX) chemotherapy and whole brain radiotherapy (WBRT). This combined regimen prolongs patient survival, but also carries a substantial risk for delayed neurotoxicity particularly in the elderly. However, cognitive outcome evaluations have not been included in most clinical trials.

OBJECTIVE

To assess cognitive functioning and quality of life in PCNSL survivors treated either with WBRT +/- MTX-based chemotherapy or chemotherapy alone.

METHODS

Twenty-eight PCNSL patients in disease remission received a post-treatment baseline neuropsychological evaluation, and a subset of patients were available for an 8-month follow-up evaluation. Assessment of quality of life and extent of white matter disease on MRI were also performed.

RESULTS

Patients displayed mild to moderate impairments across several cognitive domains. These were of sufficient severity to reduce quality of life in half of the patient sample. Comparisons according to treatment type revealed more pronounced cognitive impairment, particularly in the memory and attention/executive domains, among patients treated with WBRT +/- chemotherapy. Extent of white matter disease correlated with attention/executive, memory, and language impairment.

CONCLUSIONS

PCNSL survivors treated with WBRT +/- chemotherapy displayed more pronounced cognitive dysfunction than patients treated with MTX-based chemotherapy alone.

Cognitive status and quality of life after treatment for primary CNS lymphoma

OBJECTIVE

To evaluate the cognitive status and quality of life (QOL) in a cohort of 19 consecutive patients treated in a prospective European Organization for Research and Treatment of Cancer study (20962) for primary CNS lymphoma (PCNSL). All patients were in complete remission after combined modality treatment with IV and intrathecal high-dose methotrexate (MTX)-based chemotherapy followed by whole brain radiotherapy (WBRT).

METHODS

An extensive neuropsychological assessment, including QOL measures, was conducted in 19 patients with PCNSL. The results were compared with matched control subjects with systemic hematologic malignancies treated with systemic chemotherapy or non-CNS radiotherapy. In addition, a neuroradiologic evaluation was carried out in 18 patients with PCNSL.

RESULTS

Cognitive impairment was found in 12 patients with PCNSL (63%) despite a complete tumor response. Four patients (21%) showed severe cognitive deficits, and the percentage of impaired test indices correlated with age. In comparison, only two control subjects (11%) showed cognitive dysfunction (p = 0.002). Forty-two percent of the patients with PCNSL, in contrast to 81% of the control subjects, resumed work. White matter abnormalities were observed in 14 patients with PCNSL, and 14 had cortical atrophy. Cortical atrophy correlated with cognitive functioning, age, and Karnofsky performance score. Group differences in cognitive status and QOL could not be explained by anxiety, depression, or fatigue.

CONCLUSIONS

Combined modality treatment for primary CNS lymphoma is associated with cognitive impairment even in patients aged <60 years.

Music therapy for mood disturbance during hospitalization for autologous stem cell transplantation: a randomized controlled trial

BACKGROUND

High-dose therapy with autologous stem cell transplantation (HDT/ASCT) is a commonly used treatment for hematologic malignancies. The procedure causes significant psychological distress and no interventions have been demonstrated to improve mood in these patients. Music therapy has been shown to improve anxiety in a variety of acute medical settings. In the current study, the authors determined the effects of music therapy compared with standard care on mood during inpatient stays for HDT/ASCT.

METHODS

Patients with hematologic malignancy admitted for HDT/ASCT at two sites (Memorial Sloan-Kettering Cancer Center and Ireland Cancer Center in Cleveland, Ohio) were randomized to receive music therapy given by trained music therapists or standard care. Outcome was assessed at baseline and every 3 days after randomization using the Profile of Mood States.

RESULTS

Of 69 patients registered in the study, follow-up data were available for 62 (90%). During their inpatient stay, patients in the music therapy group scored 28% lower on the combined Anxiety/Depression scale (P = 0.065) and 37% lower (P = 0.01) on the total mood disturbance score compared with controls.

CONCLUSIONS

Music therapy is a noninvasive and inexpensive intervention that appears to reduce mood disturbance in patients undergoing HDT/ASCT.

Radioimmunotherapy for non-Hodgkin lymphoma (NHL): nursing and patient perspectives

This session addressed the major clinical endpoints of radioimmunotherapy trials, dose calculation for single administration of a radioimmunotherapy product, and strategies for the education of patients and caregivers. Attendees learned about the benefits of radioimmunotherapy from the perspective of a survivor of non-Hodgkin lymphoma.

The experience of leukaemia and bone marrow transplant: searching for meaning and agency

This qualitative study examines the experience of haematological cancer as described by ten people who have been through leukaemia or lymphoma and a bone marrow transplant. The focus is on the interaction of these participants with this challenging experience and the meaning it had for them. The descriptions of their thoughts, feelings and actions as they negotiated the period from diagnosis to treatment and survival reveal that these people brought both the present values in their life, as well as a life-long pattern of dealing with adversity, into their confrontation of a life-threatening illness. Issues of personal meaning and agency (the capacity to act and control valued aspects of one's life) were found to be paramount. These results are then discussed with a view to their implications for patient care.

Clinical hypnosis in the alleviation of procedure-related pain in pediatric oncology patients

This prospective controlled trial investigated the efficacy of a manual-based clinical hypnosis intervention in alleviating pain in 80 pediatric cancer patients (6-16 years of age) undergoing regular lumbar punctures. Patients were randomly assigned to 1 of 4 groups: direct hypnosis with standard medical treatment, indirect hypnosis with standard medical treatment, attention control with standard medical treatment, and standard medical treatment alone. Patients in the hypnosis groups reported less pain and anxiety and were rated as demonstrating less behavioral distress than those in the control groups. Direct and indirect suggestions were equally effective, and the level of hypnotizability was significantly associated with treatment benefit in the hypnosis groups. Therapeutic benefit degraded when patients were switched to self-hypnosis. The study indicates that hypnosis is effective in preparing pediatric oncology patients for lumbar puncture, but the presence of the therapist may be critical.