Ann Hematol (2003) 82:14–18
DOI 10.1007/s00277-002-0582-0
ORIGINAL ARTICLE
J. J. Gil-Fernµndez · C. Ramos · A. T. Tamayo ·
J. F. Tomµs · A. Figuera · R. Arranz ·
C. Martínez-Chamorro · J. M. Fernµndez-Raæada
Quality of life and psychological well-being in Spanish long-term
survivors of Hodgkins disease: results of a controlled pilot study
Received: 21 May 2002 / Accepted: 24 October 2002 / Published online: 19 December 2002
Springer-Verlag 2002
Abstract Nowadays, the chemoradiotherapeutic proto-
cols for Hodgkin’s disease (HD) achieve high curability
rates. Hemato-oncologists focus on both avoiding medical
and psychological sequelae of the treatment and returning
patients to a normal life. The quality of life and
psychological well-being of Spanish patients who are
long-term survivors of HD were studied and compared to
the results obtained from healthy controls. Questionnaires
on quality of life [European Organization for Research
and Treatment of Cancer (EORTC) QLQ30] and psycho-
logical status [hospital anxiety and depression (HAD)
scale] were mailed to HD patients without active disease
and free of second malignancies and were also given to
healthy controls. Of 67 selected patients (68.6%), 46 were
included in this study. The median follow-up for these 46
patients was of 7.6 years (0.8–22.1) after being diagnosed.
Although there were no differences between patients and
controls with regard to their global state of health and
quality of life (72.9€22.7 vs 79.3€18.7; p=0.22), patients
presented a lower physical function (88.2€18.1 vs
96.5€9.7; p=0.05) and a worse social operation scale
(81.5€25.4 vs 96.3€13.1; p= 0.0015) together with higher
symptoms of dyspnea (8.6€14.7 vs 0€0; p=0.03) and
higher economic difficulties (23.1€38.3 vs 0.7€4.9;
p=0.017) when compared with healthy controls. However,
we did not find differences in the scores and the
proportion of cases of anxiety and depression between
the two groups. The quality of life questionnaire disclosed
differences between patients and controls in some func-
tional and symptomatic scales. These differences can be
read as a consequence of either the disease itself or the
treatment received. However, the results of this controlled
pilot study should be confirmed in a larger series of
Spanish HD survivors. In the future, these results could be
a reference when new therapeutic protocols are designed
to reduce the impact on the quality of life of the patients.
Socioeconomic support to the patients should also be
provided in order to improve their medical care.
Keywords Hodgkin’s disease · Quality of life ·
Psychological
Introduction
It was nearly 200 years ago when in 1832 Thomas
Hodgkin described for the first time a pathological
process that affected the absorbent glands and the spleen
[13]. During the twentieth century, first radiotherapy and
then polychemotherapy were used to treat Hodgkin’s
disease (HD) beyond all expectations [10, 11, 22, 23].
Nowadays, according to the clinical characteristics of the
patients at diagnosis, conventional radiotherapy, chemo-
therapy protocols, or their combinations are used to cure
about 70–80% of the patients [3, 6, 7, 11, 19, 20, 27]. In
the last decade of the twentieth century, high doses of
chemotherapy followed by reinfusion of hematopoietic
stem cells have been used in patients refractory to
chemotherapy or those relapsing after having achieved a
complete remission [4, 5, 17, 24, 29].
The high curability indexes led the efforts of the
scientific community to look for therapeutic schemes with
the maximum effectiveness but the minimum toxicity,
avoiding long-term medical sequelae due to the damage
of several organs (heart, lungs, thyroid, or gonads) and
minimizing the risk of secondary malignancies [2, 12, 14,
25]. The current objective of the treatment of Hodgkin’s
lymphoma is to treat the disease without inducing adverse
side effects. A founded concern also exists for the
possible psychological, social, or economic sequelae
J.J. Gil-Fernµndez (
)
) · A.T. Tamayo · J.F. Tomµs · A. Figuera ·
R. Arranz · C. Martínez-Chamorro · J.M. Fernµndez-Raæada
Haematology Department, Hospital Universitario de la Princesa,
c/ Diego de Leon 62, 28006 Madrid, Spain
e-mail: jjgilfer@navegalia.com
Tel.: +34-1-3818928
Fax: +34-91-4111853
C. Ramos
Faculty of Medicine, Universidad Complutense, Madrid, Spain
J.J. Gil-Fernµndez
c/ Maria Moliner 15, 2D, 28050 Madrid, Spain