Patient Reported Experience with Fatigue, a Cross-Sectional Study Examining Indolent and Aggressive Lymphomas
Authors: C.D. Bates, O.A. Bamigbola, L.E. Warwick
Affiliation: Department of Research & Information, Lymphoma Coalition, Mississauga, ON, Canada; Management, Lymphoma Coalition, Mississauga, ON, Canada
Introduction
Cancer-related fatigue (CRF) is a persistent, subjective sense of physical, emotional, or cognitive tiredness related to cancer or cancer treatment, which negatively impacts functioning and quality of life (NCCN, 2015). The severity of CRF varies by lymphoma subtype, stage, and treatment received.
Little information is known about patients’ experience with fatigue based on the rate of disease progression (indolent or aggressive lymphomas). This study aims to provide insights into the fatigue experience of patients with indolent lymphomas compared to those with aggressive lymphomas, using the Lymphoma Coalition (LC) 2022 Global Patient Survey (GPS) on Lymphomas and CLL.
Methods
- Respondents: 8,637 total (7,113 patients and 1,524 caregivers) from 84 countries completed the 2022 LC GPS.
- Patient subgroups analyzed:
- Aggressive lymphomas (AL group, n = 2,921)
- Indolent lymphomas (IL group, including CLL, n = 4,753)
- Approach: Demographics of both groups were analyzed in relation to fatigue experiences. Chi-square and p-values were calculated, and analyses were performed with IBM SPSS v27.
Fatigue as a Symptom of Lymphoma and Treatment
- Of 6,287 respondents, 4,085 were classified as IL and 2,202 as AL.
- Prevalence: 66% (IL) and 67% (AL) reported some degree of fatigue (p = 0.3).
Alleviation of Fatigue
- Fatigue alleviation was significantly associated with treatment in AL relative to IL (p < 0.001).
Fatigue and Health-Related Quality of Life
- Fatigue was perceived as more severe in AL than IL.
- IL respondents: typically mild-to-moderate fatigue.
- AL respondents: more often moderate-to-severe fatigue (p < 0.001).
Duration of Fatigue
- Fatigue duration was longer in IL than AL.
Areas of Functioning Affected by Fatigue
- General activities: 62%
- Mood: 49–55%
- Physical activities: 51–59%
- General work and home tasks: 50–53%
- Social activities: 41–44%
- Enjoyment of life: 36–37%
Communication and Help Provided by Physicians
- Patients with IL were more likely to discuss fatigue with their treating physician compared to AL.
- Interaction on fatigue was significantly higher in IL (p < 0.001).
Coping with Fatigue
- Respondents favored exercise and adherence to schedules as the main coping strategies.
Conclusions
- Fatigue is the leading physical issue affecting patients with indolent and aggressive lymphomas.
- Differences exist in fatigue severity and duration between the groups, likely related to disease type, symptoms, treatment, and communication with doctors.
- Over 50% of patients reported that when they expressed fatigue to doctors, it was not addressed or followed up.
- Fatigue has a multifactorial nature with no standard treatment; tailored interventions are needed.
- Fatigue must be recognized and treated at all stages of disease, per standard clinical practice guidelines.
- Healthcare providers and patients need to improve communication about fatigue.
Notes
- Indolent lymphomas: CLL/SLL, Cutaneous, Follicular, Marginal zone (all subtypes), MALT, Hypoplasia, Mycosis Fungoides, Sezary Syndrome, LPL.
- Aggressive lymphomas: Immunoblastic, T-cell, Adult T-cell, Burkitt, Anaplastic large cell, DLBCL, Transformed follicular, Transformed indolent T-cell, Hairy cell, Hodgkin lymphoma, NK/T-cell, Peripheral T-cell.
* Includes diagnosed, in treatment, remission, or relapse. Post-treatment but not in remission, relapsed, or refractory excluded.
** Fatigue alleviated vs unchanged/worsened.
*** Treatment-experienced patients only.
Conflict-of-Interest Disclosures and Contact Information
- Sponsors: Pfizer Inc, AbbVie Corporation, Roche, BMS, Pharmacyclics, Takeda Oncology.
- None of the authors benefited personally from the research.
For more details on the LC 2022 GPS, visit:
👉 www.lymphomacoalition.org/global-patient-survey
Contact:
C. Bates, Head of Research, Lymphoma Coalition
📧 cherie@lymphomacoalition.org
Summary
- Purpose: To compare patient-reported experiences of fatigue in indolent lymphomas (IL) vs aggressive lymphomas (AL), using data from the 2022 Lymphoma Coalition Global Patient Survey (8,637 respondents, 84 countries).
- Key Findings:
- Prevalence: Fatigue was reported by ~66–67% of patients in both IL and AL.
- Severity: AL patients reported more moderate-to-severe fatigue, while IL patients more often described mild-to-moderate fatigue.
- Duration: Fatigue lasted longer in IL than AL.
- Impact on life: Fatigue affected general activities, mood, physical activity, work, social life, and enjoyment of life.
- Physician interaction: IL patients were more likely to discuss fatigue with their doctors; however, >50% of all patients felt it was not addressed or followed up.
- Coping strategies: Exercise and structured schedules were most commonly used.
- Conclusion:
Fatigue is the leading physical issue affecting lymphoma patients regardless of type. It differs in severity and duration between IL and AL. Fatigue is under-recognized and undertreated, highlighting the need for better communication and targeted interventions across all disease stages.