title: Mortality is persistently increased in Hodgkin's lymphoma survivors.
abstract: BACKGROUND
  Negative health outcomes of chronic fatigue (CF) in disease-free cancer survivors are mainly unexplored. Aims of this study were to examine mortality and causes of death in Hodgkin's lymphoma survivors (HLSs) compared to controls from the general population, and to explore if CF was associated with increased mortality.
  
  
  METHODS
  HLSs (n=557) invited to participate in a survey on late effects in 1994 were divided into three groups: participants without CF (n=329), participants with CF (n=113), non-participants (n=98). Controls matched for gender and age were drawn from the general population (five per HLSs, n=2785). Observation time was calculated from 1st January 1994 until date of death or cut-off at 1st January 2007. Kaplan-Meier plots were used for univariate analyses and Cox models for multiple covariates.
  
  
  RESULTS
  Compared to controls HLSs had nearly five times higher mortality (HR=4.93; 95% confidence interval [CI]: 3.91-6.21) and the mortality rate of HLSs was higher than the rate of their controls for the entire observation period. Mortality was increased in all groups: participants with CF: HR=4.85 (95% CI: 3.02-7.77), participants without CF: HR=4.35 (95% CI: 3.16-6.00), non-participants: HR=9.45 (95% CI: 5.44-16.41). Compared to the controls HLSs had over six times increased mortality of cancer (HR: 6.6, 95% CI: 4.7-9.2) and almost five times increased mortality of cardiovascular diseases (HR: 4.9, 95% CI: 3.1-7.9).
  
  
  CONCLUSIONS
  HLSs had almost five-time increased mortality compared to controls. CF was not associated with increased mortality rate. The high mortality among the non-participating HLSs indicates that serious health problems are underestimated in this group. This has implications for the interpretation of surveys in cancer survivors.
authors.affiliation: National Resource Center for Late Effects, Department of Oncology, Oslo University Hospital and University of Oslo, Norway. cecilie.essholt.kiserud@radiumhospitalet.no
authors.forename: Cecilie E
authors.initials: CE
authors.lastname: Kiserud
authors.forename: Jon Håvard
authors.initials: JH
authors.lastname: Loge
authors.forename: Alexander
authors.initials: A
authors.lastname: Fosså
authors.forename: Harald
authors.initials: H
authors.lastname: Holte
authors.forename: Milada
authors.initials: M
authors.lastname: Cvancarova
authors.forename: Sophie D
authors.initials: SD
authors.lastname: Fosså
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002423:Cause of Death; D002908:Chronic Disease; D018572:Disease-Free Survival; D005221:Fatigue / Q000401:mortality*; D005260:Female; D006689:Hodgkin Disease / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D017741:Survivors / Q000706:statistics & numerical data*; D055815:Young Adult