青少年和青年霍奇金淋巴瘤幸存者的长期身体生活质量：风险因素及与不良健康结局的关联

Purpose: Few studies characterize patient-reported outcomes in long-term survivors of adolescent and young adult (AYA, age 15-39 years at diagnosis) Hodgkin Lymphoma (HL). The present study aims to describe long-term health outcomes of survivors and identify the impact of cancer diagnosis and treatment exposures on health and quality of life (QoL). Methods: This study included AYA HL survivors (N=264) previously treated at MD Anderson Cancer Center who were at least 5 years post diagnosis. At time of study enrollment, participants completed a comprehensive health questionnaire, which included the SF-36 QoL questionnaire. The SF-36 was used to calculate Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. A subset of HL patients (N=44) had also previously completed the SF-12 questionnaire within 6 weeks of diagnosis. In parallel, 67 siblings of cancer survivors completed the same health questionnaire. Clinical characteristics and treatment information were obtained from the medical record. Area deprivation index (ADI) was calculated based on zip code at time of questionnaire completion. Results: The median age at HL diagnosis and questionnaire completion of 26.0 and 41.8 years, respectively. Survivors had a significantly poorer PCS compared to siblings (45.3 vs 47.5, p=0.03), as well as a greater proportion of individuals with extremely poor PCS scores (scores ≤40; 16% vs 10%). Among HL survivors, no difference in PCS was observed by race/ethnicity (p=0.82). However, survivors who resided in neighborhoods with increased deprivation had significantly lower PCS compared to those in the highest resource neighborhoods (p=0.003). Treatment exposures and clinical characteristics were also related to PCS, in which survivors who received radiation treatment and had HL relapse were linked to lower PCS scores compared to survivors who did not (44.5 vs 46.7, p=0.03 and 43.5 vs 45.9, p=0.04). Survivors with extremely poor PCS reported increased prevalence of adverse health outcomes, such as diagnoses impacting cardiovascular, respiratory, and nervous systems (p<0.001 for each) compared to survivors with a PCS >40. These patients also reported increased cholesterol, pain, and depression medication use (p<0.001 for each). No differences in mental QoL defined by the MCS were observed between survivors and siblings. Conclusion: HL is characterized by long-term survival, making health outcomes and QoL integral aspects of their cancer experience. This study showed that long-term survivors of HL experience reduced physical QoL. Moreover, this reduction is related to adverse health outcomes, underscoring the necessity of long-term support and clinical interventions to improve physical health for HL survivors.