Health-Related Quality of Life in Non-Hodgkin Lymphoma Survivors: A Prospective Cohort Study

  • Kang, Danbee (Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University) ;
  • Cho, Juhee (Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University) ;
  • Kim, Im Ryung (Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Mi Kyung (Samsung Biomedical Research Institute, Samsung Medical Center) ;
  • Kim, Won Seog (Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Seok Jin (Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University)
  • Received : 2017.04.29
  • Accepted : 2017.11.07
  • Published : 2018.10.15


Purpose We evaluated health-related quality of life (HRQOL) in long-term survivors of indolent and aggressive non-Hodgkin lymphoma (NHL). Materials and Methods The HRQOL was assessed by the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 (EORTC QLQ-C30) at diagnosis in NHL patients between 2008 and 2011, and follow-up evaluation was conducted from June 2014 to February 2015 using EORTC QLQ-C30 and the quality of life in cancer survivors (QOL-CS) questionnaire. We used linear mixed models to compare changes in HRQOL between indolent and aggressive NHL over time. Results The HRQOL of long-term survivors with aggressive NHL improved to the similar level of indolent NHL during the follow-up survey. However, survivors of NHL were found to fear the probability of relapse and second malignancy, and the degree of fear was not different between survivors with aggressive stage I/II or III/IV NHL (p > 0.05). Furthermore, a half of survivors reported impaired sense of psychosocial well-being regardless of aggressiveness and stage during follow-up survey. More than 65% of survivors thought they did not receive sufficient support from others, and patients who had financial difficulties at diagnosis were more frequently associated with suffering from insufficient support. Impaired physical and cognitive functioning at diagnosis was significantly associated with lack of life purpose in long-term survivors. Conclusion The HRQOL of aggressive NHL survivors improved to a similar level to that of indolent NHL. However, the majority of survivors still had fear of relapse, and psychosocial well-being remained unmet needs.


Supported by : Samsung Medical Center


  1. Howlader N, Krapcho M, Miller D, Bishop K, Altekruse SF, Kosary CL, et al. SEER cancer statistics review, 1975-2013. Bethesda, MD: National Cancer Institute; 2016.
  2. Jung KW, Won YJ, Oh CM, Kong HJ, Lee DH, Lee KH, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2014. Cancer Res Treat. 2017;49:292-305.
  3. Molina A. A decade of rituximab: improving survival outcomes in non-Hodgkin's lymphoma. Annu Rev Med. 2008;59:237-50.
  4. Khan N, Cheson BD. PTCL therapies: a review of treatment and outline of novel therapies. Am J Ther. 2013;20:524-33.
  5. Safdari Y, Ahmadzadeh V, Farajnia S. CD20-targeting in B-cell malignancies: novel prospects for antibodies and combination therapies. Invest New Drugs. 2016;34:497-512.
  6. Pfreundschuh M, Kuhnt E, Trumper L, Osterborg A, Trneny M, Shepherd L, et al. CHOP-like chemotherapy with or without rituximab in young patients with good-prognosis diffuse large-B-cell lymphoma: 6-year results of an open-label randomised study of the MabThera International Trial (MInT) Group. Lancet Oncol. 2011;12:1013-22.
  7. Oerlemans S, Mols F, Nijziel MR, Lybeert M, van de Poll-Franse LV. The impact of treatment, socio-demographic and clinical characteristics on health-related quality of life among Hodgkin's and non-Hodgkin's lymphoma survivors: a systematic review. Ann Hematol. 2011;90:993-1004.
  8. Oerlemans S, Mols F, Issa DE, Pruijt JH, Peters WG, Lybeert M, et al. A high level of fatigue among long-term survivors of non-Hodgkin's lymphoma: results from the longitudinal population-based PROFILES registry in the south of the Netherlands. Haematologica. 2013;98:479-86.
  9. Smith SK, Mayer DK, Zimmerman S, Williams CS, Benecha H, Ganz PA, et al. Quality of life among long-term survivors of non-Hodgkin lymphoma: a follow-up study. J Clin Oncol. 2013;31:272-9.
  10. Kim SH, Kim IR, Kim SH, Lee S, Ok O, Kim WS, et al. Healthrelated quality of life in Korean lymphoma survivors compared with the general population. Ann Hematol. 2014;93:1531-40.
  11. Arden-Close E, Pacey A, Eiser C. Health-related quality of life in survivors of lymphoma: a systematic review and methodological critique. Leuk Lymphoma. 2010;51:628-40.
  12. Mols F, Aaronson NK, Vingerhoets AJ, Coebergh JW, Vreugdenhil G, Lybeert ML, et al. Quality of life among long-term non-Hodgkin lymphoma survivors: a population-based study. Cancer. 2007;109:1659-67.
  13. Smith SK, Zimmerman S, Williams CS, Zebrack BJ. Health status and quality of life among non-Hodgkin lymphoma survivors. Cancer. 2009;115:3312-23.
  14. Jensen RE, Arora NK, Bellizzi KM, Rowland JH, Hamilton AS, Aziz NM, et al. Health-related quality of life among survivors of aggressive non-Hodgkin lymphoma. Cancer. 2013;119:672-80.
  15. Kim SH, Lee S, Kim SH, Ok ON, Kim IR, Choi E, et al. Unmet needs of non-Hodgkin lymphoma survivors in Korea: prevalence, correlates, and associations with health-related quality of life. Psychooncology. 2017;26:330-6.
  16. Yun YH, Park YS, Lee ES, Bang SM, Heo DS, Park SY, et al. Validation of the Korean version of the EORTC QLQ-C30. Qual Life Res. 2004;13:863-8.
  17. Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A. The EORTC QLQ-C30 scoring manual. 3rd ed. Brussels: European Organization for Research and Treatment of Cancer; 2001.
  18. Stromgren AS, Goldschmidt D, Groenvold M, Petersen MA, Jensen PT, Pedersen L, et al. Self-assessment in cancer patients referred to palliative care: a study of feasibility and symptom epidemiology. Cancer. 2002;94:512-20.
  19. Ferrell BR, Dow KH, Grant M. Measurement of the quality of life in cancer survivors. Qual Life Res. 1995;4:523-31.
  20. Cho J, Kang D, Kim IR, Kim WS, Ferrell B, Kim SJ. Validation of the Korean version of the Quality of Life-Cancer Survivors (QOL-CS-K) questionnaire in lymphoma survivors. Cancer Res Treat. 2018;50:204-11.
  21. Blaes AH, Ma L, Zhang Y, Peterson BA. Quality of life appears similar between survivors of indolent and aggressive non- Hodgkin lymphoma. Leuk Lymphoma. 2011;52:2105-10.
  22. Jung HA, Park S, Cho JH, Kim S, Ko YH, Kim SJ, et al. Prognostic relevance of pretreatment quality of life in diffuse large B-cell lymphoma patients treated with rituximab-CHOP: results from a prospective cohort study. Ann Hematol. 2012;91:1747-56.
  23. Mertz BG, Dunn-Henriksen AK, Kroman N, Johansen C, Andersen KG, Andersson M, et al. The effects of individually tailored nurse navigation for patients with newly diagnosed breast cancer: a randomized pilot study. Acta Oncol. 2017;56:1682-9.
  24. Crist JV, Grunfeld EA. Factors reported to influence fear of recurrence in cancer patients: a systematic review. Psychooncology. 2013;22:978-86.
  25. Lebel S, Maheu C, Lefebvre M, Secord S, Courbasson C, Singh M, et al. Addressing fear of cancer recurrence among women with cancer: a feasibility and preliminary outcome study. J Cancer Surviv. 2014;8:485-96.
  26. Gill KM, Mishel M, Belyea M, Germino B, Germino LS, Porter L, et al. Triggers of uncertainty about recurrence and longterm treatment side effects in older African American and Caucasian breast cancer survivors. Oncol Nurs Forum. 2004;31:633-9.
  27. Oerlemans S, Husson O, Mols F, Poortmans P, Roerdink H, Daniels LA, et al. Perceived information provision and satisfaction among lymphoma and multiple myeloma survivors: results from a Dutch population-based study. Ann Hematol. 2012;91:1587-95.
  28. Epstein RM, Street RL. Patient-centered communication in cancer care: promoting healing and reducing suffering. Bethesda, MD: National Cancer Institute; 2007.
  29. Phillips T, Mercer J. Surveillance scans in lymphoma: friend or foe? Curr Treat Options Oncol. 2017;18:10.
  30. Guidot DM, Switchenko JM, Nastoupil LJ, Koff JL, Blum KA, Maly J, et al. Surveillance imaging in mantle cell lymphoma in first remission lacks clinical utility. Leuk Lymphoma. 2018;59:888-95.
  31. Thompson CA, Charlson ME, Schenkein E, Wells MT, Furman RR, Elstrom R, et al. Surveillance CT scans are a source of anxiety and fear of recurrence in long-term lymphoma survivors. Ann Oncol. 2010;21:2262-6.
  32. El-Galaly TC, Jakobsen LH, Hutchings M, de Nully Brown P, Nilsson-Ehle H, Szekely E, et al. Routine imaging for diffuse large B-cell lymphoma in first complete remission does not improve post-treatment survival: a Danish-Swedish population-based study. J Clin Oncol. 2015;33:3993-8.
  33. Abernethy AP, Etheredge LM, Ganz PA, Wallace P, German RR, Neti C, et al. Rapid-learning system for cancer care. J Clin Oncol. 2010;28:4268-74.
  34. Gil KM, Mishel MH, Belyea M, Germino B, Porter LS, Clayton M. Benefits of the uncertainty management intervention for African American and White older breast cancer survivors: 20-month outcomes. Int J Behav Med. 2006;13:286-94.
  35. Molassiotis A, Wilson B, Blair S, Howe T, Cavet J. Unmet supportive care needs, psychological well-being and quality of life in patients living with multiple myeloma and their partners. Psychooncology. 2011;20:88-97.
  36. Stanton AL. What happens now? Psychosocial care for cancer survivors after medical treatment completion. J Clin Oncol. 2012;30:1215-20.