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Health Status and Quality of Life in Patients With Early-Stage Hodgkin’s Disease Treated on Southwest Oncology Group Study 9133

Patricia A. Ganz, Carol M. Moinpour, Donna K. Pauler, Alice B. Kornblith, Ellen R. Gaynor, Stanley P. Balcerzak, Gretchen S. Gatti, Harry P. Erba, Sheryl McCoy, Oliver W. Press, Richard I. Fisher

From the University of California, Los Angeles, Los Angeles, CA; Dana-Farber Cancer Institute, Boston, MA; Loyola University Stritch School of Medicine, Maywood, IL; Ohio State University Health Center, and Columbus Community Clinical Oncology Program, Columbus, OH; University of Michigan Medical Center, Ann Arbor, MI; Southwest Oncology Group Statistical Center, and Puget Sound Oncology Consortium, Seattle, WA; and University of Rochester School of Medicine, Rochester, NY.

Address reprint requests to Southwest Oncology Group (SWOG-9208), Operations Office, 14980 Omicron Dr, San Antonio, TX 78245-3217.

Purpose: We describe the short and intermediate-term quality-of-life (QOL) outcomes in patients treated on a randomized clinical trial in early-stage Hodgkin’s disease (Southwest Oncology Group [SWOG] 9133) comparing subtotal lymphoid irradiation (STLI) with combined-modality treatment (CMT).

Patients and Methods: Two hundred forty-seven patients participated in the QOL study (SWOG 9208), completing several standardized instruments (Symptom Distress Scale; Cancer Rehabilitation Evaluation System – Short Form; Medical Outcomes Study 36-Item Short-Form Health Survey Vitality Scale; and a health perception item), as well as questions about work, marital status, and concerns about having children. This article reports on results from baseline before random assignment, at 6 months, and at 1 and 2 years after random assignment.

Results: Patients receiving CMT experienced significantly greater symptom distress (P < .0001), fatigue (P = .001), and poorer QOL (P = .015) at 6 months than the STLI patients, reflecting a shorter time since completion of therapy in the CMT arm. Importantly, patients in the two groups did not differ on any outcomes at the 1-and 2-year assessments. Both patient groups reported significantly more fatigue before treatment than healthy reference populations, and fatigue did not improve in either group after treatment.

Conclusion: This study demonstrated that patients with early-stage Hodgkin’s disease experience a short-term decrease in QOL and an increase in symptoms and fatigue with treatment, which is more severe with CMT; by 1 year, however, CMT and STLI patients report similar outcomes. Fatigue scores for both arms were lower at baseline than scores for the general population and did not return to normal levels 2 years after random assignment. The mechanisms responsible for this lingering problem warrant further investigation.

This investigation was supported in part by the following Public Health Service Cooperative Agreement grant numbers awarded by the National Cancer Institute, Department of Health and Human Services, Washington, DC: CA38926, CA32102, CA46282, CA04920, CA65261, CA32291, CA27057, CA46368, CA22433, CA45377, CA20319, CA13612, CA35176, CA58415, CA76447, CA45807, CA58723, CA12644, CA63845, CA46113, CA76132, CA58861, CA35192, CA12213, CA35281, CA52654, CA35128, CA76429, CA04919, CA42777, CA63844, CA58416, CA58658, CA16385, CA67575, CA35996, CA14028, CA37981, CA35090, CA35262, CA58348, CA28862, CA76462, CA35119, CA35431. Dr Ganz is also supported by a Clinical Research Professorship from the American Cancer Society, Atlanta, GA.

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