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Late Medical Complications and Fatigue in Hodgkin’s Disease Survivors

From the Unit for Applied Clinical Research, Faculty of Medicine, Norwegian University of Science and Technology, and Palliative Care Unit, Department of Oncology, Trondheim University Hospital, Trondheim; Department of Behavioral Sciences in Medicine and Division of Heart and Lung Diseases, National Hospital, University of Oslo; and Norwegian Radium Hospital, Oslo, Norway.

Address reprint requests to Heidi Knobel, MD, Unit for Applied Clinical Research, Trondheim University Hospital, Norwegian University of Science and Technology, N-7006 Trondheim, Norway; email: heidi.knobel{at}medisin.ntnu.no

PURPOSE: Long-term medical complications, such as cardiac, pulmonary, and thyroid dysfunction, are frequent among Hodgkin’s disease survivors (HDSs). Chronic fatigue is also highly prevalent among HDSs. Few studies have explored possible etiologic explanations for fatigue. The aim of this study was to explore whether late cardiac, pulmonary, and thyroid complications after curative treatment for Hodgkin’s disease (HD) may explain the high level of fatigue among HDSs.

PATIENTS AND METHODS: Four-hundred fifty-nine patients treated for HD at the Norwegian Radium Hospital from 1971 to 1991 were included in a cross-sectional, follow-up study of subjective health status. Fatigue (physical [PF] and mental), was measured by the Fatigue Questionnaire. A subcohort of the HDSs (116 patients) treated from 1980 to 1988 were included in a separate study in which long-term cardiac, pulmonary, and thyroid complications were assessed. All patients had received radiotherapy, and 63 patients had received additional chemotherapy. The present study comprised 92 patients (mean age, 37 years; range, 23 to 56 years) who participated in both studies.

RESULTS: HDSs with pulmonary dysfunction were more fatigued than HDSs with normal pulmonary function (PF 10.9 v 8.9; P < .05). Gas transfer impairment was the most prevalent pulmonary dysfunction, and three times as many patients with gas transfer impairment reported chronic fatigue (duration, 6 months or longer), compared with patients without pulmonary dysfunction (48% v 17%, P < .01). No associations were found between cardiac sequelae or hypothyroidism and fatigue.

CONCLUSION: Pulmonary dysfunction is associated with fatigue in HDSs. Cardiac sequelae was not associated with fatigue in HDSs. We question the absence of an association between thyroid complications and fatigue.

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