Health-related quality of life and its influencing factors in patients with primary cutaneous B-cell lymphomas: A multicentric study in 100 patients.

BACKGROUND: Primary cutaneous B-cell lymphomas (CBCL) are a group of rare malignant skin diseases that represent approximately 20%-30% of all primary cutaneous lymphomas (PCL). Previous studies revealed impaired health-related quality of life (HRQoL) in patients diagnosed with primary cutaneous T-cell lymphoma (CTCL). Currently, only small-sized studies investigated HRQoL in CBCL patients and lacked detailed analysis of respective subtypes. OBJECTIVES: This study aims to investigate HRQoL in CBCL patients to identify independent factors of HRQoL impairment in CBCL patients. METHODS: One hundred CBCL patients were recruited from eight German PCL centres in this multicentric, cross-sectional study from 2021 to 2022. The patients completed the dermatologic HRQoL questionnaire Skindex-29 and an investigator-designed 'CBCL-Questionnaire' with additional questions on HRQoL and clinical characteristics. RESULTS: The Skindex-29 revealed that HRQoL in CBCL patients is impaired on a mild to moderate level. The multiple regression analysis identified parameters like worries about dying, feeling prejudiced/discriminated and impairment of daily activities to be independently associated with impairment of HRQoL. Highest scores for HRQoL impairment were found in patients with primary cutaneous follicle centre lymphoma while on rituximab treatment and in patients with primary cutaneous marginal zone lymphoma while on watchful waiting. CONCLUSIONS: HRQoL is impaired in CBCL patients, even though, in the face of indolent disease course and favourable prognosis in the majority of cases. Of note, our investigator-designed tool identified worries about dying, feeling prejudiced/discriminated, and the type of treatment to have a negative impact on patients' HRQoL. Our study highlights the importance of a thorough patient-doctor communication to capture overall disease burden because generic HRQoL tools might lack of disease-specific items.

Health-related Quality of Life in Cutaneous Lymphomas: Past, Present and Future.

Previous studies have reported that primary cutaneous lymphomas profoundly influence patients' health-related quality of life (HRQoL). However, assessment of this psycho-social concept is not common in routine patient care unless required within clinical trials. The aim of this review is to provide a comprehensive overview of HRQoL measures and outcomes in cutaneous lym-phomas in order to inform clinicians. Advanced-stage cutaneous lymphomas were found to be associated with worse HRQoL than early-stage disease. Specifically, progression of the disease, age, sex, psychosocial issues, educational level and therapy were related to the extent of impairment of HRQoL. Treatment response was linked to improved HRQoL, but notably ameliorated HRQoL scores were also reported despite objective disease response. However, the variety of instruments applied to measure HRQoL in cutaneous lymphomas makes it difficult to compare data directly. In conclusion, speciality-specific HRQoL instruments were superior to generic ones, which probably failed to recognize small, but relevant, changes, demonstrating the need for a disease-specific tool.

Quality of life in survivors of adult haematological malignancy.

BACKGROUND: Survivors of haematological malignancies endure long-term effects of both treatment and disease. This paper examines factors that influence their quality of life through reporting on the results of a survey. METHODS: Survey using previously validated quality of life questionnaires for use in cancer management. Participants were adults aged 18 and over who had completed treatment for a haematological malignancy and were between 1 and 5 years post-treatment. FINDINGS: A total of 131 participants, median age of 66, completed questionnaires (66% response rate). Significant associations were found between age, global quality of life, physical and role functioning. Men reported better physical functioning and lower symptom scores than women. Employed participants reported better quality of life. Increasing age was associated with lowest quality of life. Best role functioning was also noted in participants who lived beyond 2.5 years following treatment completion. The survey suggested a gender difference with men reporting better physical functioning, fewer symptoms of pain and less loss of sleep compared with women. CONCLUSION: This study contributes to the underdeveloped area of care for and research into adult haematological cancer survivors. Knowledge and understanding of the factors that affect the quality of life of such adults may provide an insight into implementation measures.

Patients' Illness Perception as a Tool to Improve Individual Disease Management in Primary Cutaneous Lymphomas.

The Revised Illness Perception Questionnaire (IPQ-R) has been shown to assess illness perception reproducibly in primary cutaneous T-cell lymphomas (CTCL). Illness perception reflects patients' individual concepts of understanding and interpretation of the disease, influencing illness behaviour and health-related quality of life (HRQOL). This study investigated the clinical relevance of the relationships between illness perception, illness behaviour, and HRQOL in CTCL and cutaneous B-cell lymphomas (CBCL). A total of 92 patients completed the IPQ-R, the Scale for the Assessment of Illness Behavior (SAIB), and a skin-specific HRQOL tool (Skindex-29). Data on illness behaviour were not evidently related to illness perception, whereas illness perception was significantly associated with HRQOL. Both, IPQ-R and HRQOL results correlated with disease entity, stage, and socio-demographics. Only IPQ-R results provided practical information on patients' needs to train personal coping strategies. IPQ-R assessment in CTCL and CBCL might be a useful instrument to improve individual disease management.

Cancer-specific geriatric assessment and quality of life: important factors in caring for older patients with aggressive B-cell lymphoma.

PURPOSE: To evaluate the efficacy and tolerability of chemotherapy, a geriatric assessment is recommended in elderly patients with cancer. We aimed to characterize and compare patients with aggressive lymphoma by objective response and survival status based on pre-treatment cancer-specific geriatric (C-SGA) and quality of life (QoL) assessments. METHODS: Patients not eligible for anthracycline-based first-line therapy or intensive salvage regimens completed C-SGA and QoL assessment before and after a rituximab-bendamustine-lenalidomide (R-BL) treatment in a phase II clinical trial. Clinical outcomes were compared based on pre-treatment individual and summary C-SGA measures, their cutoff-based subcategories and QoL indicators, using Wilcoxon rank sum or chi-square tests. RESULTS: A total of 57 patients (41 included in the clinical trial) completed a C-SGA. Participants with pre-treatment impaired functional status (Vulnerable Elders Survey-13 score ≥3) were more likely to experience worse outcomes: a higher proportion were non-responders, died before the median follow-up of 31.6 months (interquartile range (IQR) 27.9-37.9) or died during treatment. Non-responders were patients categorized as having possible depression (Geriatric Depression Scale-5 score ≥2) and with worse QoL scores for functional performance. Patients with worse C-SGA summary scores and with greater tiredness were more likely to die during treatment. CONCLUSION: A pre-treatment impaired functional status is an important factor with respect to clinical outcomes in patients receiving an R-BL regimen. Individual geriatric and related QoL domains showed similar associations with clinical outcomes. Whether interventions targeting specific geriatric dimensions also translate in better symptom- or domain-specific QoL warrants further research.

[Bilateral hippocampal primary CNS lymphoma: unusual differential diagnosis of rapid progressive dementia]. / Bilaterales hippocampales primäres ZNS-Lymphom: ungewöhnliche Differentialdiagnose eines rasch progredienten dementiellen Syndroms.

We report on a 63-year old man suffering from rapid progressive dementia due to bilateral hippocampal primary CNS lymphoma. Early diagnosis especially in secondary dementia is essential because of potentially treatable aetiologies with regression of cognitive and behaviour abnormalities. Characteristic imaging findings especially in inflammatory and neoplastic lesions affecting the hippocampal structures are discussed.

Primary central nervous system lymphoma.

INTRODUCTION: Primary central nervous system lymphoma is a rare subtype of extranodal non-Hodgkin lymphoma that accounts for 4% of central nervous system tumours. PATIENTS AND METHODS: Retrospective review of 24 patients diagnosed with primary central nervous system lymphoma between 1990 and 2010. All patients were diagnosed using magnetic resonance imaging and the diagnosis was confirmed surgically. RESULTS: Of the 24 patients analysed, all except 4 were immunocompetent. Median age at diagnosis was 59.3 years (range 13-79) and the sex ratio (male to female) was 1:1.1. Cognitive decline (in 33.4%) and headache (in 25%) were the most common complaints. Diagnosis was performed In 13 cases (54%) following craniotomy and in the other 11 cases (46%) after stereotactic biopsy. Breakdown by pathology was as follows: 22 cases of B-cell lymphoma (91.6%), 1 case of anaplastic large-cell lymphoma, and 1 case of T-cell lymphoma. Mean survival time was 12.8 months with an overall 1-year survival rate of 37.5%. CONCLUSIONS: Primary central nervous system lymphoma often presents in the sixth decade with cognitive decline, headache, and focal neurological deficits. A single intracranial lesion was present in 75% of the patients (18 cases), and the remaining 25% (6 cases) had between 2 and 4 lesions. Preoperative clinical status was the most important factor determining prognosis.

Quality of life and psychological distress in patients with cutaneous lymphoma.

BACKGROUND: Cutaneous lymphomas may have a profound impact on patients' health-related quality of life (HRQoL) and psychological well-being. OBJECTIVES: To evaluate HRQoL and psychological distress in patients with cutaneous lymphoma, and to evaluate them in relation to personal and clinical characteristics. METHODS: Patients with cutaneous T-cell lymphoma or cutaneous B-cell lymphoma (CBCL) were consecutively recruited in a dermatological hospital. Data on HRQoL were collected using a dermatology-specific questionnaire, the Skindex-29, and an oncology-specific questionnaire, the EORTC QLQ-C30. RESULTS: Of 95 patients, there were 24 with CBCL, 59 with mycosis fungoides (MF) and 12 with Sézary syndrome (SS). The most frequent items reported in Skindex-29 were itching and sensitive skin, being annoyed by the disease, worry that it could get worse, affected interactions, and impairment in sexual life. The most frequent problems appearing from the EORTC QLQ-C30 analysis were fatigue, pain and insomnia. A worse HRQoL was observed for all the scales in patients with SS, followed by MF, and CBCL. HRQoL impairment in all histotypes was higher in women than in men, in patients with probable anxiety or depression, and when the disease worsened. The highest prevalence of probable anxiety or depression was observed in patients treated with systemic steroids (60%) and interferon (50%). CONCLUSIONS: The detailed evaluation of HRQoL and psychological problems in patients with cutaneous lymphomas, and their relationship with clinical variables, may give important information on the burden of the disease for patients, and thus improve communication and satisfaction with care.

Diagnostic and surgical pitfalls of an unusual primary central nervous system lymphoma.

BACKGROUND: Here we describe a case of PCNSL which was located peripherally as a single lesion and showed no evidence of pathological findings of lymphoma at the first biopsy. CASE DESCRIPTION: A 56-year-old man was admitted to the hospital with a talking disorder and attention deficit. The neurological examination was normal. There was a left temporoparietal, 24 x 20 mm. enhanced lesion on MRI. The patient underwent a craniotomy and the lesion was excised totally. The pathological examination revealed glial tissue which showed reactive astrocyte proliferations. A month later, an MRI was performed and a recurrent tumor was seen near the first lesion's location. The second operation was performed via the same craniotomy, the tumor was excised totally and the second pathological examination revealed diffuse large-cell, B-lymphoma. There were no pathological findings on abdominal, thoracic and bone marrow investigations. CONCLUSION: PCNSL may show various biological behaviors. Using steroids before the biopsy may lead to diagnostic and therapeutic failure.

The course of anxiety, depression and unmet needs in survivors of diffuse large B cell lymphoma and multiple myeloma in the early survivorship period.

PURPOSE: The purpose of the study is to examine the course of anxiety, depression and unmet needs in diffuse large B cell lymphoma (DLBCL) and multiple myeloma (MM) survivors in the first 2 years post diagnosis. METHODS: DLBCL and MM survivors, recruited through the Victorian Cancer Registry, completed two interviews approximately 7 and 15 months post diagnosis. Hospital Anxiety and Depression Scale (HADS) and Supportive Care Needs Survey (SCNS-SF34) were completed at both interviews. Primary outcomes were prevalence of anxiety, depression and unmet needs (any or moderate-high). Generalized estimating equation examined whether course of anxiety, depression and unmet needs differed between the two cancers. RESULTS: Overall, 236 DLBCL and 178 MM survivors completed both telephone interviews. Course of anxiety differed (p < 0.01) with rate increasing in DLBCL (14 to 22%) while remaining stable for MM (15 to 12%). Course of depression also differed (p < 0.01), decreasing for MM (22 to 12%) and remaining stable for DLBCL (15 to 16%) survivors. Change in unmet needs was generally similar for the two cancer groups, except for moderate to high psychological needs (p < 0.05). CONCLUSIONS: Patterns of change in anxiety and depression in first 2 years post diagnosis differ for DLBCL and MM survivors. IMPLICATIONS FOR CANCER SURVIVORS: Studying psychological outcomes in mixed haematological cancer samples may be inappropriate, at least in the early survivorship phase. Separate studies of the experiences of people with the different haematological cancer subtypes are needed to ensure psychosocial and supportive care interventions are appropriate to the needs of individuals with different haematological cancers.

A view from the other side. A doctor's experience of having lymphoma.

BACKGROUND: Most doctors will at some point in their lives find themselves 'on the other side' in the role of patient. This may pose particular challenges both for the individual and for those involved in their treatment. OBJECTIVE: To document the personal experience of a doctor becoming a patient grappling with the potentially life threatening condition of non-Hodgkins lymphoma. DISCUSSION: Being a doctor with a life threatening condition brings all of the familiar personal emotional challenges and reactions of any other patient. However, this is further compounded by the complex and unfamiliar nature of the relationship between the doctor as a patient and their own treating health professionals. Developing sound, trusting, and mutually respectful professional relationships is essential to ensuring doctors receive the same high quality of care when they find themselves in the patient role.

The course of anxiety and depression for patients with Hodgkin's lymphoma or diffuse large B cell lymphoma: a longitudinal study of the PROFILES registry.

PURPOSE: The purpose of this study is to prospectively assess anxiety and depression among patients with Hodgkin lymphoma (HL) and diffuse large B cell lymphoma (DLBCL). Also, to compare its prevalence with a normative population, identify subgroups with more anxiety and depression, and assess its impact on health-related quality of life (HRQoL). METHODS: The population-based Eindhoven Cancer Registry was used to select patients diagnosed with HL or DLBCL from 1999 to 2010, 489 responded (T1). The HADS was completed four times (T1-T4), with a 1-year interval. Linear mixed-models were used to assess the course of anxiety and depression and identify high-risk subgroups. RESULTS: Both anxiety and depression were reported more often by patients compared to the normative population (p < 0.05). Over the four time points, approximately 10% of patients reported to be always and 15% reported to be sometimes anxious or depressed. Anxiety and depression did not improve in time. Patients with comorbidity and patients who were lower educated reported higher anxiety and depression scores (p < 0.05). Younger DLBCL patients reported higher anxiety scores, whereas older DLBCL patients reported higher depression scores over time (p < 0.05). Global health status/HRQoL was clinically relevant lower in patients with anxiety and depression and this appeared to be constant over time. CONCLUSION: More HL and DLBCL patients experience anxiety and depression compared to their counterparts in the general population and it did not improve in time. IMPLICATION FOR CANCER SURVIVORS: Clinicians should be aware that former lymphoma patients with anxiety and depression have a deteriorated global health status/HRQoL and refer patients to suitable aftercare when necessary.

Quality of life following treatment for B-cell lymphoma.

Clinical outcome for B-cell non-Hodgkin's lymphoma has been greatly improved through the combination of new treatment options, in particular noncytotoxic drugs that specifically target disease mechanisms. Furthermore, in many cases, lymphoma survivors have to cope with long-term toxicity. Therefore, as with survival and remission length, the assessment of quality of life (QoL) is a major consideration when judging therapeutic benefit in patients. The aim of this article is to discuss the impact of widespread treatments on QoL and the relevance of QoL assessment in B-cell non-Hodgkin's lymphoma in day-to-day clinical practice. Additional studies of QoL in the general population, the associations between QoL and treatment strategy, QoL and specific situations (i.e., stem-cell transplantation and aging population) are also considered.

Environmental enrichment augments the efficacy of idiotype vaccination for B-cell lymphoma.

Environmental enrichment is known to positively influence the organism's psychologic and physiologic well-being. However, the effects of environmental enrichment on immune responses and cancer prognosis have not been clearly established and its impact on cancer therapy is unknown. Here, we report that environmental enrichment mediated a statistically significant improvement of the outcome of immunotherapy in an experimental model of B-cell lymphoma. When mice were immunized with an idiotype-vaccine, those maintained under enriched environmental conditions produced statistically significant higher levels of anti-idiotype antibodies and revealed more attenuated tumor growth than those housed in standard environments. Most strikingly, enriched tumor-bearing mice had statistically significant prolonged survival, with 44% of them disease-free compared with 0% in the standard rearing tumor-bearing mice. The possible mechanisms for the enhancement of immunotherapy by environmental enrichment are cognitive, physical activity, and psychologic. The demonstration of synergistic effect of cancer therapy and environmental enrichment on tumor rejection has important implication for cancer treatment.