Cancer-related fatigue in lymphoma and chronic lymphocytic leukemia (CLL)

Cancer-related fatigue (CRF) unfortunately remains an unmet need: prevalent yet underreported, poorly understood and difficult to address. In collaboration with the Lymphoma Coalition, four researchers conducted a cross-sectional global survey study of patients with lymphoma or lymphoma in 2022. Chronic lymphocytic leukemia To determine whether patients with chronic lymphocytic leukemia (CLL) perceive CRF as a symptom of their disease, as a side effect (AE) of treatment, or both, the research team obtained evaluable responses from 6,758 patients from 71 countries. The results were reported Cancer Research Communication.¹

Not surprisingly, consistent with the more aggressive lymphoma subtype, patients who received more intensive treatments experienced the most CRF.

Cancer-related fatigue remains widespread, under-reported, poorly understood and difficult to treat, experts say | Image credit: EmeraldRaindrops-stock.adobe.com

CRF has been recognized for many years.2 However, it remains true that CRF is a disease symptom, and while effective disease treatment would logically alleviate CRF as a symptom, treatment AEs may replace or even mask symptomatic relief, the authors noted. Lymphoma patients are a vulnerable population, and treatment protocols should be improved to reduce the burden of CRF, the team argued. They estimated that just under 50% of CRF reported by survey respondents was due to treatment-disease association.

The psychological aspects of CRF remain unclear, the researchers added. It remains unclear to what extent psychological factors help cause CRF, or to what extent CRF helps cause substantial psychological effects, or both. Identifying patients at highest risk for CRF also remains difficult. But the lack of clear answers does not change the fact that increased screening and monitoring for fatigue would improve patient outcomes, the researchers added.

“We advocate for an expansion of the definition of precision medicine,” they added.[It should] “Not only is it important to provide the right patients with the most appropriate anti-cancer treatment, but it is also important to ensure that patients receive the right supportive care.”

Data details

The survey focused on patient-reported outcomes and patient-reported experience measures. Overall, 65% of respondents were from France, the United States, China, Italy, Australia, and the United Kingdom. The largest number of respondents were from CLL (n = 1222), follicular lymphoma (n = 1071), and Diffuse large B-cell lymphoma (DLBCL; n = 906).

Combined with patient age and biological sex, CRF showed significant predictive value for DLBCL, follicular lymphoma, and mantle cell lymphoma (MCL) (P≤ .02). All other subtypes failed to achieve statistical significance for this set of predictors, the researchers noted.P < .0001) and follicular lymphoma (P = .05), and women were more likely than men to experience fatigue as a symptom and adverse event.

Increasing age was also a predictor of respondents reporting fatigue as both a symptom and an adverse event of follicular lymphoma (P = .03) and MCL (P = .004).

“The effect of age in MCL was amplified with regard to the fatigue-age trade-off compared with other subtypes. [an AE] It is seen only in young patients and symptoms include [AE] “In elderly patients,” the authors explained.

Across all subtypes, the mean percentage of fatigue attributable to treatment was 34% (range, 0%-45%).In patients with Hodgkin lymphoma, DLBCL, breast implant-associated anaplastic large cell lymphoma, MCL, peripheral T-cell lymphoma, and follicular lymphoma, 40% or more of CRF could be attributed to treatment.

Clinical parameters commonly associated with CRF include impaired performance status, use of pharmaceutical painkillers, gastrointestinal disorders, poor sleep, and abnormal hemoglobin and albumin levels, the authors noted.

References

1. Kalloger SE, Watson A, Sajkowski S, Warwick L. Additive effects of cancer-related fatigue and treatment in lymphoma: an analysis of the Lymphoma Coalition's 2022 Global Patient Survey. Cancer Res Commun. Published online June 5, 2024. doi:10.1158/2767-9764.CRC-24-0048

2. Stein KD, Syrjala KL, Andrykowski MA. Long-term and late physical and psychological effects of cancer. cancer2008;112(Suppl 11):2577-2592. doi:10.1002/cncr.23448