High Level of Fatigue in Lymphoma Patients Treated With High Dose Therapy

Knobel, Heidi; Loge, Jon Håvard; Nordøy, Tone; Kolstad, Arne L.; Espevik, Terje; Kvaløy, Stein; Kaasa, Stein

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Volume 19, Issue 6 , Pages 446-456, June 2000

High Level of Fatigue in Lymphoma Patients Treated With High Dose Therapy

Heidi Knobel, MD
- Unit for Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway
- Address reprint requests to: Heidi Knobel, MD, Unit for Applied Clinical Research, The Faculty of Medicine, Norwegian University of Science and Technology, Trondheim University Hospital, N-7006 Trondheim, Norway
Jon Håvard Loge, MD
- Unit for Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Behavioral Sciences in Medicine, University of Oslo, Oslo, Norway
Tone Nordøy, MD
- Department of Oncology, Tromsø University Hospital, Tromsø, Norway
Arne L. Kolstad, MD, PhD
- Department of Oncology, Tromsø University Hospital, Tromsø, Norway
Terje Espevik, MD, PhD
- The Faculty of Medicine, and Institute of Cancer Research, Norwegian University of Science and Technology, Trondheim, Norway
Stein Kvaløy, MD, PhD
- Unit for Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway
- The Norwegian Radium Hospital, Oslo, Norway
- Palliative Care Unit, Department of Oncology, Trondheim University Hospital, Trondheim, Norway
Stein Kaasa, MD, PhD
- Unit for Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway
- The Norwegian Radium Hospital, Oslo, Norway
- Palliative Care Unit, Department of Oncology, Trondheim University Hospital, Trondheim, Norway

Accepted 14 July 1999.

Abstract

With the success of high dose therapy supported by autologous bone marrow transplantation (ABMT) for malignant lymphomas, medical late-effects and secondary effects on subjective health, like fatigue, are of concern. Fatigue is poorly understood and correlates have been barely addressed. Health-related quality of life (HRQL), fatigue, and correlates to fatigue, including endocrinological status and serum levels of interleukin-6, tumor necrosis factor, and soluble tumor necrosis factor receptors, were investigated in a cross-sectional study of 33 lymphoma patients (median age 39 years) 4–10 years after ABMT. The survivors were compared to general population norms. Fatigue was highly prevalent, and females reported significantly more fatigue and impaired HRQL compared to males and the normal population. Gonadal dysfunction was found in the majority of the patients, but no statistically significant endocrinological or immunological associations with fatigue could be demonstrated. The high level of fatigue among female long-term survivors after ABMT may be related to the gonadal dysfunction, but further studies of possible mechanisms behind fatigue are necessary.

Keywords: Fatigue, cancer, quality of life, high dose therapy, autologous bone marrow transplantation, cytokines, sex hormones