(ChemotherapyAdvisor) – The presence of comorbidity or symptom burden in long-term survivors of non-Hodgkin lymphoma (NHL) “should alert the clinician to a potential need for supportive services,” a study reported in the Journal of Clinical Oncology online December 3.

This is especially important for patients whose quality of life (QOL) steadily deteriorates over time, yet who no longer receive health care from an oncology or survivorship clinic, noted Sophia K. Smith, PhD, of Duke Cancer Institute, Duke University Medical Center, Durham, NC, and colleagues. “Consequently, they may lack much-needed support at later stages of survivorship when they have become invisible to the system of care.”

Advances in the treatment of NHL have led to improved survival; consequently, more than 500,000 individuals in the United States are living with a history of NHL. “However, NHL survivors are an understudied group,” Dr. Smith noted. “Little is known about the longitudinal effects of recurrence and/or systemic treatment on QOL-related outcomes such as health and functioning.”

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The investigators mailed surveys to 682 NHL survivors who had participated in a study 5 years earlier; 566 (83%) participated in the current survey. Mean years postdiagnosis was 15.3; 52% were women, and 87% were white.

“One third of participants (32%) reported persistently high or improved QOL, yet a notable proportion (42%) reported persistently low or worsening QOL since the earlier survey,” the investigators found.

Independent predictors of poor QOL were older age, more comorbidity, and more or increasing negative and decreasing positive perceptions of cancer’s impact; the latter was related to lymphoma symptom burden, less social support, and having received transplantation.

An improvement in physical health was noted by those who received only biologic systemic therapy.

“Our results show that QOL and the cancer experience, and their changes over time, are complex. Although we can signal specific subpopulations at risk, there isn’t a one-size-fits-all approach; it is difficult to predict the long-term outcome for any particular person,” they reported.

These results suggest patient-reported monitoring should be integrated as a standard of survivorship care.