Cancer-related fatigue in Hodgkin's lymphoma

Cancer-related fatigue (CrF) is among the most frequently observed patient-reported impairments in Hodgkin lymphoma (HL) survivors. The aim of this paper was an evidence-based systematic review of CrF in HL and of current therapeutic options. By a systematic literature search, relevant publications and new developments in the treatment of CrF in current trials were summarized. CrF is prevalent in HL patients even before the onset of chemotherapy and differs significantly between disease stages. In sharp contrast to these different fatigue levels at baseline, fatigue during therapy and more importantly long-term fatigue is remarkably similar across all different stages of HL. Accordingly, we did not observe a negative impact of treatment intensity on the development of long-term fatigue. Fatigue at baseline is a strong predictor of fatigue after treatment. Subtypes of long-term fatigue development result primarily from different baseline fatigue levels. Survivor groups with severe baseline fatigue tend to remain at high fatigue levels during the observation period of 5 years. However, the vast majority of survivors of more advanced stage HL with moderate fatigue at baseline can expect remarkable improvement after successful therapy of HL. The presence of severe fatigue prevents HL patients from social reintegration and thus has major implications for their life as survivors. In the fifth year after therapy, the number of survivors without severe fatigue working or in an educational training program was nearly 30% higher compared to those with severe fatigue. There is evidence that exercise programs and cognitive behaviour therapy help to ameliorate CrF. Further randomized, clinical trials are needed to improve the outcome and quality of life of HL survivors suffering from CrF