title: Cancer-Related Fatigue in Patients With and Survivors of Hodgkin Lymphoma: The Impact on Treatment Outcome and Social Reintegration.
abstract: Purpose Cancer-related fatigue occurs frequently in patients with Hodgkin lymphoma (HL) and has a major impact on their quality of life. We hypothesized that severe fatigue (sFA) might have an impact on patients' treatment outcome and social reintegration. Methods Of 5,306 patients enrolled in the German Hodgkin Study Group's fifth generation of clinical trials in HL (HD13, HD14, and HD15; nonqualified and older [> 60 years] patients excluded), 4,529 provided data on health-related quality of life. We describe sFA (defined as a score ≥ 50 on the 0 to 100 scale from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30) before and up to 9 years after therapy and analyze its impact on treatment outcome and social reintegration. Results The proportion of patients reporting sFA was 37% at baseline and ranged from 20% to 24% during follow-up. Baseline sFA was associated with significantly impaired progression-free survival and a trend to impaired overall survival, which can be overcome in patients receiving highly effective HL therapies as applied in our fifth-generation trials. Our analysis revealed a significant negative association of sFA and employment in survivors: 5 years after therapy, 51% and 63% of female and male survivors, respectively, with sFA were working or in professional education, compared with 78% and 90% without sFA, respectively ( P < .001 adjusted for age, sex, stage, baseline employment status, and treatment outcome). sFA was also associated with financial problems and the number of visits to a general practitioner and medical specialists. Conclusion sFA is an important factor preventing survivors from social reintegration during follow-up. This observation underscores the need to address fatigue as a significant diagnosis when treating patients with and survivors of cancer.
authors.affiliation: Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg, Austria; Peter Moosmann, Cantonal Hospital Aarau AG, Aarau and Swiss Group for Clinical Cancer Research, Berne, Switzerland; and Oluwatoyin Shonukan, Boston University School of Public Health, Boston, MA.
authors.forename: Karolin
authors.initials: K
authors.lastname: Behringer
authors.affiliation: Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg, Austria; Peter Moosmann, Cantonal Hospital Aarau AG, Aarau and Swiss Group for Clinical Cancer Research, Berne, Switzerland; and Oluwatoyin Shonukan, Boston University School of Public Health, Boston, MA.
authors.forename: Helen
authors.initials: H
authors.lastname: Goergen
authors.affiliation: Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg, Austria; Peter Moosmann, Cantonal Hospital Aarau AG, Aarau and Swiss Group for Clinical Cancer Research, Berne, Switzerland; and Oluwatoyin Shonukan, Boston University School of Public Health, Boston, MA.
authors.forename: Horst
authors.initials: H
authors.lastname: Müller
authors.affiliation: Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg, Austria; Peter Moosmann, Cantonal Hospital Aarau AG, Aarau and Swiss Group for Clinical Cancer Research, Berne, Switzerland; and Oluwatoyin Shonukan, Boston University School of Public Health, Boston, MA.
authors.forename: Indra
authors.initials: I
authors.lastname: Thielen
authors.affiliation: Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg, Austria; Peter Moosmann, Cantonal Hospital Aarau AG, Aarau and Swiss Group for Clinical Cancer Research, Berne, Switzerland; and Oluwatoyin Shonukan, Boston University School of Public Health, Boston, MA.
authors.forename: Corinne
authors.initials: C
authors.lastname: Brillant
authors.affiliation: Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg, Austria; Peter Moosmann, Cantonal Hospital Aarau AG, Aarau and Swiss Group for Clinical Cancer Research, Berne, Switzerland; and Oluwatoyin Shonukan, Boston University School of Public Health, Boston, MA.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Kreissl
authors.affiliation: Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg, Austria; Peter Moosmann, Cantonal Hospital Aarau AG, Aarau and Swiss Group for Clinical Cancer Research, Berne, Switzerland; and Oluwatoyin Shonukan, Boston University School of Public Health, Boston, MA.
authors.forename: Teresa Veronika
authors.initials: TV
authors.lastname: Halbsguth
authors.affiliation: Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg, Austria; Peter Moosmann, Cantonal Hospital Aarau AG, Aarau and Swiss Group for Clinical Cancer Research, Berne, Switzerland; and Oluwatoyin Shonukan, Boston University School of Public Health, Boston, MA.
authors.forename: Julia
authors.initials: J
authors.lastname: Meissner
authors.affiliation: Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg, Austria; Peter Moosmann, Cantonal Hospital Aarau AG, Aarau and Swiss Group for Clinical Cancer Research, Berne, Switzerland; and Oluwatoyin Shonukan, Boston University School of Public Health, Boston, MA.
authors.forename: Richard
authors.initials: R
authors.lastname: Greil
authors.affiliation: Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg, Austria; Peter Moosmann, Cantonal Hospital Aarau AG, Aarau and Swiss Group for Clinical Cancer Research, Berne, Switzerland; and Oluwatoyin Shonukan, Boston University School of Public Health, Boston, MA.
authors.forename: Peter
authors.initials: P
authors.lastname: Moosmann
authors.affiliation: Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg, Austria; Peter Moosmann, Cantonal Hospital Aarau AG, Aarau and Swiss Group for Clinical Cancer Research, Berne, Switzerland; and Oluwatoyin Shonukan, Boston University School of Public Health, Boston, MA.
authors.forename: Oluwatoyin
authors.initials: O
authors.lastname: Shonukan
authors.affiliation: Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg, Austria; Peter Moosmann, Cantonal Hospital Aarau AG, Aarau and Swiss Group for Clinical Cancer Research, Berne, Switzerland; and Oluwatoyin Shonukan, Boston University School of Public Health, Boston, MA.
authors.forename: Jens Ulrich
authors.initials: JU
authors.lastname: Rueffer
authors.affiliation: Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg, Austria; Peter Moosmann, Cantonal Hospital Aarau AG, Aarau and Swiss Group for Clinical Cancer Research, Berne, Switzerland; and Oluwatoyin Shonukan, Boston University School of Public Health, Boston, MA.
authors.forename: Hans-Henning
authors.initials: HH
authors.lastname: Flechtner
authors.affiliation: Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg, Austria; Peter Moosmann, Cantonal Hospital Aarau AG, Aarau and Swiss Group for Clinical Cancer Research, Berne, Switzerland; and Oluwatoyin Shonukan, Boston University School of Public Health, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Fuchs
authors.affiliation: Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg, Austria; Peter Moosmann, Cantonal Hospital Aarau AG, Aarau and Swiss Group for Clinical Cancer Research, Berne, Switzerland; and Oluwatoyin Shonukan, Boston University School of Public Health, Boston, MA.
authors.forename: Volker
authors.initials: V
authors.lastname: Diehl
authors.affiliation: Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg, Austria; Peter Moosmann, Cantonal Hospital Aarau AG, Aarau and Swiss Group for Clinical Cancer Research, Berne, Switzerland; and Oluwatoyin Shonukan, Boston University School of Public Health, Boston, MA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Engert
authors.affiliation: Karolin Behringer, Helen Goergen, Horst Müller, Indra Thielen, Corinne Brillant, Stefanie Kreissl, Michael Fuchs, Volker Diehl, Andreas Engert, and Peter Borchmann, University Hospital of Cologne; Jens Ulrich Rueffer, German Fatigue Society, Cologne; Teresa Veronika Halbsguth, University Hospital of Frankfurt, Frankfurt; Julia Meissner, University of Heidelberg, Heidelberg; Hans-Henning Flechtner, Otto von Guericke University, Magdeburg, Germany; Richard Greil, Paracelsus Medical University, Salzburg, Austria; Peter Moosmann, Cantonal Hospital Aarau AG, Aarau and Swiss Group for Clinical Cancer Research, Berne, Switzerland; and Oluwatoyin Shonukan, Boston University School of Public Health, Boston, MA.
authors.forename: Peter
authors.initials: P
authors.lastname: Borchmann
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D004651:Employment / Q000706:statistics & numerical data*; D005221:Fatigue / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D005858:Germany; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012917:Social Adjustment; D012959:Socioeconomic Factors; D017741:Survivors; D055815:Young Adult