Quality of Life After Hodgkin Lymphoma Treatment
The final sample consisted of 40 young adult survivors of HL ranging in age from 21–41 years (see Table 1). The participants were primarily female and married. Only 10% of the participants (n = 4) lived with a parent. About 88% (n = 35) of the participants were employed or earning income within the past 12 months; 10% (n = 4) were fully retired from paid employment. Eighty percent (n = 32) of the participants had stage I or II HL and 17% (n = 8) had stage III or IV. Sixty percent (n = 19) of the early-stage participants received single modality treatment.
Analyses revealed that distressing and bothersome physical symptoms improved significantly from one to six months following treatment (see Table 2). Overall improvement in symptom distress was evident through significantly lower mean scores at all time points (p < 0.0001) compared to baseline. Data were approximately normally distributed at baseline only; therefore, the Wilcoxon signed rank tests were used in lieu of parametric statistics to compare scores at the various time points. Pairwise comparisons revealed significant differences in symptom distress between baseline and as soon as one month (p < 0.0001).
Dichotomous groups were created to differentiate those with moderate-to-severe symptom distress, indicated by an SDS score of 25 or higher, from those with low symptom distress, indicated by an SDS score of 24 or lower. Fifty percent (n = 20) of the participants reported moderate-to-severe distress at baseline, 11% (n = 4) at one month, 16% (n = 6) at three months, and 11% (n = 4) at six months. For those who reported moderate to severe distress at baseline, 20% (n = 8) received CMT and, by six months, 11% (n = 4) of the participants who received CMT continued to report moderate-to-severe distress.
Examination of emotional distress scores revealed an overall significant difference from end of treatment (baseline) to six months following treatment using the Friedman test (p < 0.0001). Pairwise comparisons revealed significant improvements in total HADS depression and anxiety scores from baseline to one month post-treatment (p = 0.006). Emotional distress was demonstrated by combined cut off scores at or above moderate (8 or higher) to severe (11 or higher) levels of HADS anxiety and depression scores, respectively. Only 13% (n = 5) of the participants had severe anxiety at baseline, which decreased to 8% (n = 3) by six months after treatment completion. Although the incidence of severe anxiety decreased to 3% (n = 1) at one month, it then increased to 5% (n = 2) at three months, and again slightly increased to 8% at six months (n = 3). Depression scores improved significantly from baseline to one month (p = 0.01), but no significant improvement was noted in anxiety levels (p = 0.029) for the same data collection points based on the Bonferroni correction levels of 0.0167. Except for baseline, mean combined scores of anxiety and depression were all within the normal range.
The average mean score for both IOC questions used to measure intimate relationships increased slightly from baseline to six months, although the analysis revealed that the only significant difference in scores (p = 0.0003) was from end of treatment (baseline) to one month for the question regarding the special bond with people with cancer.
Functional status significantly improved overall from end of treatment (baseline) to six months using the Friedman test (p < 0.0001). Pairwise comparisons revealed a significant increase in scores only from baseline to one month (p < 0.0001).
The use of supportive care services declined over time (see Table 3), from 49 inquiries at baseline to 40 inquiries at six months. Sixty-eight percent (n = 27) of the participants used one or more services at baseline, but the use of services declined somewhat to 55% (n = 21) at six months. Twenty-four participants had questions regarding employee rights, health insurance, disability, and other legal and financial information at baseline, which declined to 16 inquiries at six months. Participation in emotional support groups (14%, n = 7) was used as a supportive care service at baseline, including professional and peer counseling. Participation in health behavior programs (n = 11, 22%), such as nutrition and exercise programs, were used as a supportive care service at baseline by the participants. Different forms of physical therapy were used at baseline by 14% of participants (n = 7), including pain management and physical and alternative therapies. Whereas economic inquiries declined at six months, the use of health behavior programs, particularly fitness programs, increased at six months.
Results
Sample Demographics
The final sample consisted of 40 young adult survivors of HL ranging in age from 21–41 years (see Table 1). The participants were primarily female and married. Only 10% of the participants (n = 4) lived with a parent. About 88% (n = 35) of the participants were employed or earning income within the past 12 months; 10% (n = 4) were fully retired from paid employment. Eighty percent (n = 32) of the participants had stage I or II HL and 17% (n = 8) had stage III or IV. Sixty percent (n = 19) of the early-stage participants received single modality treatment.
Symptom Distress
Analyses revealed that distressing and bothersome physical symptoms improved significantly from one to six months following treatment (see Table 2). Overall improvement in symptom distress was evident through significantly lower mean scores at all time points (p < 0.0001) compared to baseline. Data were approximately normally distributed at baseline only; therefore, the Wilcoxon signed rank tests were used in lieu of parametric statistics to compare scores at the various time points. Pairwise comparisons revealed significant differences in symptom distress between baseline and as soon as one month (p < 0.0001).
Dichotomous groups were created to differentiate those with moderate-to-severe symptom distress, indicated by an SDS score of 25 or higher, from those with low symptom distress, indicated by an SDS score of 24 or lower. Fifty percent (n = 20) of the participants reported moderate-to-severe distress at baseline, 11% (n = 4) at one month, 16% (n = 6) at three months, and 11% (n = 4) at six months. For those who reported moderate to severe distress at baseline, 20% (n = 8) received CMT and, by six months, 11% (n = 4) of the participants who received CMT continued to report moderate-to-severe distress.
Emotional Distress
Examination of emotional distress scores revealed an overall significant difference from end of treatment (baseline) to six months following treatment using the Friedman test (p < 0.0001). Pairwise comparisons revealed significant improvements in total HADS depression and anxiety scores from baseline to one month post-treatment (p = 0.006). Emotional distress was demonstrated by combined cut off scores at or above moderate (8 or higher) to severe (11 or higher) levels of HADS anxiety and depression scores, respectively. Only 13% (n = 5) of the participants had severe anxiety at baseline, which decreased to 8% (n = 3) by six months after treatment completion. Although the incidence of severe anxiety decreased to 3% (n = 1) at one month, it then increased to 5% (n = 2) at three months, and again slightly increased to 8% at six months (n = 3). Depression scores improved significantly from baseline to one month (p = 0.01), but no significant improvement was noted in anxiety levels (p = 0.029) for the same data collection points based on the Bonferroni correction levels of 0.0167. Except for baseline, mean combined scores of anxiety and depression were all within the normal range.
Intimate Relationships
The average mean score for both IOC questions used to measure intimate relationships increased slightly from baseline to six months, although the analysis revealed that the only significant difference in scores (p = 0.0003) was from end of treatment (baseline) to one month for the question regarding the special bond with people with cancer.
Functional Status
Functional status significantly improved overall from end of treatment (baseline) to six months using the Friedman test (p < 0.0001). Pairwise comparisons revealed a significant increase in scores only from baseline to one month (p < 0.0001).
Supportive Care Services
The use of supportive care services declined over time (see Table 3), from 49 inquiries at baseline to 40 inquiries at six months. Sixty-eight percent (n = 27) of the participants used one or more services at baseline, but the use of services declined somewhat to 55% (n = 21) at six months. Twenty-four participants had questions regarding employee rights, health insurance, disability, and other legal and financial information at baseline, which declined to 16 inquiries at six months. Participation in emotional support groups (14%, n = 7) was used as a supportive care service at baseline, including professional and peer counseling. Participation in health behavior programs (n = 11, 22%), such as nutrition and exercise programs, were used as a supportive care service at baseline by the participants. Different forms of physical therapy were used at baseline by 14% of participants (n = 7), including pain management and physical and alternative therapies. Whereas economic inquiries declined at six months, the use of health behavior programs, particularly fitness programs, increased at six months.
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