Health-Related Quality of Life in Hematological Malignancy Patients in Northwestern Turkey

The diagnosis of a hematological malignancy and its treatment potentially lead to severe symptoms and signs that negatively affect quality of life (QoL). In spite of its importance, there is very limited data about QoL in hematological malignancies in our country, Turkey.

We aimed to evaluate the prevalence and predictors of symptoms and problems in a representative group of hematological malignancy patients in northwestern part of Turkey. In addition, we investigated the relationship between QoL and clinical features in these patients.

Our center is a university hospital which functions as a tertiary referral center. It is located in northwestern part of Turkey and serves a population of approximately one million people. Most of them are from rural areas. Our center is equipped with all the facilities needed to diagnose and follow-up patients with all types of hematological malignancies.

Hematological malignancy patients who had been diagnosed and treated at our hematology department within the last 5 years were included. Local ethical committee consent was obtained. We reviewed the medical records of all patients and we obtained clinical data about their demographical features, diagnosis, and treatment status. Patients who had a known serious cognitive dysfunction or had a severe psychiatric comorbidity were not included.

For assessing QoL, all hematologic malignancy patients were asked to respond to the EORTC QLQ-C30. For the five function scales and global health status or QoL, higher scores represent better functioning. For the nine symptom scales, higher scores correspond to more symptoms. In addition, all subjects were administered the Hospital Anxiety and Depression Scale (HADS).

The study sample consisted of 332 hematological malignancy patients. One-hundred patients had nonHodgkin's lymphoma (NHL), 89 patients had multiple myeloma (MM), 53 had chronic myeloid leukemia (CML), 44 had acute myeloid leukemia (AML), 32 had Hodgkin's lymphoma (HL) and 14 had acute lymphoblastic leukemia (ALL).

The symptom with the highest mean score was fatigue (40.9±28.4), followed by pain (30.5±31.8), insomnia (28.2±33.9) and appetite loss (25.9±33.7). The function scale with the lowest mean score was financial function (29.9±34.4).

Using the cutoff values (for symptom scale ≥33, for function scale ≤67), 73.1% of the patients had decreased financial function, 39% of the patients had decreased physical function, 28.7% patients had reduced role function and social function, 24.5% of the patients decreased emotional function, 15.4% patients had decreased cognitive function. In addition, 26.5% patients had fatigue, 24.1% of the patients had insomnia, 22.3% patients had pain (severe), 23% of patients had appetite loss, 13.5% of patients had constipation, 5.7% of patients had nausea, 5.3% of patients had diarrhea.

In multivariate logistic regression analysis, factors having negative effect on physical function were older age, the presence of anxiety and depression; factors negatively affecting role function were similarly anxiety and depression; factors having negative effect on financial function were the presence of depression and lower educational level. Multivariate analysis showed that the presence of anxiety and depression were independent factors negatively affecting fatigue which was quite frequent. The presence of depression, on the other hand, was an independent factor which negatively influenced the presence of severe pain.

The mean global quality of life score was 60.6±25.8. We observed the highest global QoL scores in CML (73.5±20.7) and in CLL (71±21.4) patients; and the lowest scores in ALL (52.8±33.6) and NHL (58.5±24.5) patients. However, their differences were not significant.

Multivariate linear regression analysis revealed that independent factors which influenced global QoL score were anxiety according to HADS-A score (OR: −6.6, 95%CI: −1.2, −12.04, p=0.018); and depression (OR=−22.2, 95%CI: 15.4, −28.8, p<0.001) and active disease (OR: 7.2, 95%CI: 1.16–13.2, p=0.019) according to HADS-D score.

In our center which mainly serves hematological malignancy patients from rural areas, the most important loss of function was in financial function. Anxiety and depression had negative influence on functional parameters; and positive influence on symptom scores.

No relevant conflicts of interest to declare.