title: Chronic fatigue in Hodgkin lymphoma survivors and associations with anxiety, depression and comorbidity.
abstract: BACKGROUND
  Fatigue is a frequent and persistent problem among Hodgkin lymphoma (HL) survivors. We investigated the prevalence of clinically relevant fatigue in HL survivors and the relation between fatigue and anxiety and depression.
  
  
  METHODS
  Fatigue was measured through the generic European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) and Fatigue Assessment Scale (FAS). Anxiety and depression were measured with the Hospital Anxiety and Depression Scale. Questionnaires were mailed to 267 HL survivors. Results were compared with a Dutch age-matched normative population.
  
  
  RESULTS
  Response rate was 68% (median age 46 years, mean time since diagnosis 4.6 years). Prevalence of fatigue was significantly higher among HL survivors than in the norm population (FAS 41% vs 23%, QLQ-C30 43% vs 28%), as were fatigue levels. There was a significant association between fatigue, anxiety and depression. Of the HL survivors with high symptom levels of depression, 97% also reported fatigue. In multivariate analysis, depression was strongly associated with high levels of fatigue and, to a lesser extent, anxiety and comorbidity.
  
  
  CONCLUSIONS
  Prevalence rates of fatigue are significantly higher in HL survivors than in the general population and differences are clinically relevant. Depression and anxiety were strongly associated with high levels of fatigue. Reducing fatigue levels by treatment of depression and anxiety should be further explored.
authors.affiliation: Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: L A
authors.initials: LA
authors.lastname: Daniëls
authors.affiliation: 1] Comprehensive Cancer Centre South, Eindhoven, The Netherlands [2] Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Oerlemans
authors.affiliation: Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: A D G
authors.initials: AD
authors.lastname: Krol
authors.affiliation: Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: C L
authors.initials: CL
authors.lastname: Creutzberg
authors.affiliation: 1] Comprehensive Cancer Centre South, Eindhoven, The Netherlands [2] Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, The Netherlands.
authors.forename: L V
authors.initials: LV
authors.lastname: van de Poll-Franse
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology*; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005221:Fatigue / Q000453:epidemiology*; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy / Q000453:epidemiology* / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D011795:Surveys and Questionnaires; D017741:Survivors