Johannsdottir Inga M R, Hamre Hanne, Fosså Sophie D, Loge Jon Håvard, Drolsum Liv, Lund May Brit, Nordsletten Lars, Kiserud Cecilie
1 Department for Pediatric Cancers and Blood Disorders, Oslo University Hospital , Oslo, Norway .
2 National Advisory Unit on Late Effects After Cancer Treatment, Oslo University Hospital , Oslo, Norway .
J Adolesc Young Adult Oncol. 2017 Sep;6(3):470-476. doi: 10.1089/jayao.2017.0018. Epub 2017 Aug 24.
The increased incidence of physical and psychosocial adverse health outcomes (AHOs) in childhood lymphoma survivors (CLSs) is well known, but these AHOs' association with self-reported general health is rarely described.
We explored this association among long-term CLSs.
In 124 CLSs (Hodgkin: 81; non-Hodgkin: 43; median age: 33 years), physical AHOs were graded based on slightly modified common toxicity criteria for adverse effects (CTCAE)-4 recommendations (Grade 0-3). Psychosocial AHOs (pain, work inability, fatigue, and mental distress) were mainly assessed by validated patient-reported questionnaires (Grade 0-2). The results were related to contemporary self-reported general health. Statistical significance: p < 0.01.
At least one physical AHO was found in 120 CLSs, being of Grades 1, 2, and 3, respectively, in 43, 43, and 34 survivors. The prevalence of psychosocial AHOs (Grades 1 or 2) was 63%, being Grade 2 in 62 CLSs. The CLSs described their general health as significantly reduced compared with controls, with the greatest reduction for survivors in whom physical AHOs were combined with moderate to severe psychosocial AHOs.
Psychosocial more than physical AHOs impact on CLSs' current self-reported general health. Clinicians responsible for follow-up of CLSs should be aware of the strong reduction of contemporary general health by Grade 2 psychosocial AHOs. The study challenges the use of the physician-assessed CTCAE-4 categories in long-term cancer survivors and emphasizes the need to develop instruments, which reflect both physical and psychosocial AHOs in these individuals.
儿童淋巴瘤幸存者（CLS）身体和心理社会不良健康结局（AHO）的发病率增加已广为人知，但这些AHO与自我报告的总体健康状况之间的关联鲜有描述。
我们探讨了长期CLS之间的这种关联。
在124名CLS（霍奇金淋巴瘤：81例；非霍奇金淋巴瘤：43例；中位年龄：33岁）中，根据对不良反应（CTCAE）-4建议的轻度修改后的常见毒性标准对身体AHO进行分级（0-3级）。心理社会AHO（疼痛、工作能力丧失、疲劳和精神困扰）主要通过经过验证的患者报告问卷进行评估（0-2级）。结果与当代自我报告的总体健康状况相关。统计学显著性：p < 0.01。
在120名CLS中发现至少一种身体AHO，43名、43名和34名幸存者的分级分别为1级、2级和3级。心理社会AHO（1级或2级）的患病率为63%，62名CLS为2级。与对照组相比，CLS将他们的总体健康状况描述为显著下降，身体AHO与中度至重度心理社会AHO合并的幸存者下降幅度最大。
心理社会AHO比身体AHO对CLS当前自我报告的总体健康状况影响更大。负责CLS随访的临床医生应意识到2级心理社会AHO会使当代总体健康状况大幅下降。该研究对长期癌症幸存者使用医生评估的CTCAE-4类别提出了挑战，并强调需要开发能够反映这些个体身体和心理社会AHO的工具。
