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Health Qual Life Outcomes. 2019 Jul 2;17(1):115. doi: 10.1186/s12955-019-1186-x.

Fatigue level changes with time in long-term Hodgkin and non-Hodgkin lymphoma survivors: a joint EORTC-LYSA cross-sectional study.

Author information

École Doctorale MIIS, University of Caen-Normandie, 14032, Caen, France.
Centre de Traitement des Données du Cancéropôle Nord-Ouest, Plateforme de Recherche Clinique Ligue Contre le Cancer, Centre François Baclesse, 3 Avenue Général Harris, 14076, Caen, Cedex 5, France.
Department of Internal Medicine, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands.
Service d'Onco-hématologie, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Hôpital l'Archet 2, 151 Route Saint-Antoine de Ginestière, BP 3079, 06202, Nice, Cedex 3, France.
Department of Radiotherapy, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands.
Service d'Hématologie, AP-HP CHU Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France.
Service d'Hématologie, Centre Henri Becquerel, Rue d'Amiens, 76000, Rouen, France.
Service d'Hématologie, Gustave Roussy Cancer Campus, 114 Rue Edouard Vaillant, 94805, Villejuif, Cedex, France.
Service d'Hématologie, AP-HP CHU Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
Service d'Hématologie, CHRU de Dijon Bourgogne, Hôpital Le Bocage, 2 Boulevard Maréchal de Lattre of Tassigny, 21000, Dijon, France.
Department of Haematology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700, RB, Groningen, the Netherlands.
Centre de Traitement des Données du Cancéropôle Nord-Ouest, Plateforme de Recherche Clinique Ligue Contre le Cancer, Centre François Baclesse, 3 Avenue Général Harris, 14076, Caen, Cedex 5, France.



Long-term lymphoma survivors often complain of persistent fatigue that remains unexplained. While largely reported in Hodgkin lymphoma (HL), long-term fatigue is poorly documented in non-Hodgkin lymphomas (NHL). Data collected in two cohort studies were used to illustrate the fatigue level changes with time in the two populations.


Two cross-sectional studies were conducted in 2009-2010 (HL) and in 2015 (NHL) in survivors enrolled in European Organisation for Research and Treatment of Cancer (EORTC) Lymphoma Group and Lymphoma Study Association (LYSA) trials. The same protocol and questionnaires were used in both studies including the Multidimensional Fatigue Inventory (MFI) tool to assess fatigue and a checklist of health disorders. Multivariate linear regression models were used in the two populations separately to assess the influence of time since diagnosis and primary treatment, age, gender, education level, cohabitation status, obesity and health disorders on fatigue level changes. Fatigue level changes were compared to general population data.


Overall, data of 2023 HL and 1619 NHL survivors with fatigue assessment available (99 and 97% of cases, respectively) were analyzed. Crude levels of fatigue were similar in the two populations. Individuals who reported health disorders (61% of HL and 64% of NHL) displayed higher levels of fatigue than those who did not (P <  0.001). HL survivors showed increasing fatigue level with age while in NHL survivors mean fatigue level remained constant until age 70 and increased beyond. HL survivors showed fatigue changes with age higher than those of the general population with health disorders while NHL survivors were in between those of the general population with and without health disorders.


Among lymphoma survivors progressive increase of fatigue level with time since treatment completion is a distinctive feature of HL. Our data suggest that changes in fatigue level are unlikely to only depend on treatment complications and health disorders. Investigations should be undertaken to identify which factors including biologic mechanisms could explain why a substantial proportion of survivors develop high level of fatigue.


Cross-sectional study; Fatigue; Hodgkin lymphoma; Long-term survivors; Non-Hodgkin lymphomas

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