title: Fatigue in male lymphoma survivors differs between diagnostic groups and is associated with latent hypothyroidism.
abstract: BACKGROUND
  Few studies have explored fatigue in different groups of lymphoma survivors and the association with hormonal dysfunctions. The aims were to analyze associations between fatigue and thyroid and gonadal function in male lymphoma survivors. In addition, the impact of chronic fatigue on work situation and daily functioning were explored.
  
  
  METHODS
  This cross-sectional study included male lymphoma survivors diagnosed in 1980-2002, aged ≤ 50 years at diagnosis and > 18 years at survey in 2007. The participants (n = 233, median age at survey: 48 years, median observation time: 15 years) completed questionnaires assessing levels of fatigue, chronic fatigue (duration ≥ 6 months), mental distress, daily functioning and work situation. Levels of thyroid and gonadal hormones were assessed. The participants were grouped according to diagnosis: Hodgkin lymphoma (HL, n = 131), aggressive/very aggressive non-Hodgkin lymphoma (NHL) (n = 67) and indolent NHL (n = 35). Thyroid hormones were categorized as normal (n = 174) or latent hypothyroidism (elevated thyroid stimulating hormone, n = 59). Gonadal hormones were categorized as normal (n = 111), elevated follicle stimulating hormone only (n = 45), primary (n = 35) or secondary hypogonadism (n = 42). Uni- and multivariate regression analyses were performed. A p value < 0.05 indicated the level of significance.
  
  
  RESULTS
  The survivors of HL and aggressive/very aggressive NHL had similar fatigue levels and similar prevalence of chronic fatigue (HL: 31%, aggressive/very aggressive; NHL: 27%). Survivors of indolent NHL had lower fatigue levels and prevalence of chronic fatigue (11%). Latent hypothyroidism was associated with increased fatigue levels (p = 0.042). Gonadal function was not associated with levels of fatigue or chronic fatigue. Mental distress was associated with increasing fatigue levels and chronic fatigue (p < 0.001). We found negative associations between chronic fatigue, daily functioning and work status.
  
  
  CONCLUSIONS
  Fatigued lymphoma survivors should be investigated for thyroid function. The negative impact of chronic fatigue on daily functioning and work status emphasizes the importance of maintaining the effort in understanding the mechanisms behind fatigue.
authors.affiliation: National Advisory Unit on Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital , Oslo , Norway.
authors.forename: Cecilie E
authors.initials: CE
authors.lastname: Kiserud
authors.forename: Mette
authors.initials: M
authors.lastname: Seland
authors.forename: Harald
authors.initials: H
authors.lastname: Holte
authors.forename: Alexander
authors.initials: A
authors.lastname: Fosså
authors.forename: Sophie D
authors.initials: SD
authors.lastname: Fosså
authors.forename: Jens
authors.initials: J
authors.lastname: Bollerslev
authors.forename: Trine
authors.initials: T
authors.lastname: Bjøro
authors.forename: Jon Håvard
authors.initials: JH
authors.lastname: Loge
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D005640:Follicle Stimulating Hormone / Q000097:blood; D006689:Hodgkin Disease / Q000097:blood / Q000150:complications* / Q000401:mortality; D006801:Humans; D007006:Hypogonadism / Q000097:blood / Q000150:complications; D007037:Hypothyroidism / Q000097:blood / Q000150:complications*; D008228:Lymphoma, Non-Hodgkin / Q000097:blood / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009664:Norway / Q000453:epidemiology; D015995:Prevalence; D011788:Quality of Life; D013315:Stress, Psychological / Q000097:blood / Q000150:complications*; D011795:Surveys and Questionnaires; D017741:Survivors; D013972:Thyrotropin / Q000097:blood; D014937:Work; D055815:Young Adult
chemical_list: D005640:Follicle Stimulating Hormone; D013972:Thyrotropin