In 1993, the EORTC-GELA H8 trial in patients with early-stage Hodgkin's lymphoma was initiated (n=1577).  In this study, after stratification by prognostic factors, patients were treated as follows:

• Very favourable prognostic factors: mantle-field radiotherapy
• Favourable prognostic factors (H8-F): randomised to either subtotal nodal radiotherapy (STNI) or three cycles of mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (MOPP-ABV) and involved-field radiotherapy (IFRT)
• Unfavourable prognostic factors (H8-U): randomised to 4-6 cycles of MOPP-ABV and IFRT or four cycles of MOPP-ABV and STNI

In the current publication, the authors report the results of the accompanying longitudinal prospective survey of health-related quality of life (HRQoL) and fatigue in patients in complete remission; the objectives were to analyse the relations between treatment, HRQoL, and fatigue, and to identify factors that predict persistent fatigue.

HRQoL assessment using questionnaires (EORTC core quality of life questionnaire [QLQ-C30], a sexual functioning scale, and the Multidimensional Fatigue Inventory (MFI-20) was planned at the end of treatment and during follow-up, every 3 months during the first year, every 4 months during the second year, every 6 months in years 3–5, and at yearly intervals thereafter for 10 years. Assessment was voluntary and stopped in cases of treatment failure.   A total of 1014 of the original 1,577 patients participated and 935 were eligible for analysis (total of 2666 assessments).   

The main findings after a mean follow-up of 90 months (range 52-118) included the following:

• Overall, 3.2% (14/439 for role functioning) to 9.7% (43/442 for social functioning) and 5.8% (29/498 for reduced motivation) to 9.9% (49/498 for general fatigue) of patients reported impairments of 10 points or more (on a 0—100 scale) in QLQ-C30 and MFI-20 scores, respectively, independent of age and sex.

• Women reported lower HRQoL and higher symptom scores than did men, and age affected all functioning and symptom scores except emotional functioning (younger age associated with higher functioning and lower severity of symptoms)

• Emotional domains were more affected than physical ones.

• There was no relationship seen between HRQoL outcome and the type of treatment received in the H8 trial.

• Fatigue (MFI-20 scores) at the end of treatment was the only predictive variable for persistent fatigue, with odds ratios varying from 2.58 (95% CI 1.00—6.67) to 41.51 (12.02—143.33; p≤0.0001).

The authors discuss the limitations of their data, concluding that their data do not prove “that less intensive treatments with reduced toxicity directly translate to an improved well-being for long-term survivors.”  They suggest that efforts should be undertaken to identify contributing factors to persistent fatigue, and describe better the patterns of recovery within the various HRQoL domains.