Chronic fatigue is the most important factor limiting health-related quality of life of chronic myeloid leukemia patients treated with imatinib

Abstract

Health-related quality of life (HRQOL) is an important goal of therapy for chronic myeloid leukemia (CML) patients treated with current molecular-targeted therapies. The main objective of this study was to investigate factors associated with long-term HRQOL outcomes of CML patients receiving imatinib. Analysis was performed on 422 CML patients recruited in an observational multicenter study. HRQOL was assessed with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Key socio-demographic and clinical data were investigated for their association with HRQOL outcomes. Chronic fatigue and social support were also investigated. Univariate and multivariate linear regression analyses were used to identify independent factors associated with HRQOL outcomes. Fatigue was the only variable showing an independent and consistent association across all physical and mental HRQOL outcomes (P<0.01). Differences between patients reporting low versus high fatigue levels were more than eight and seven times the magnitude of a clinically meaningful difference, respectively, for the role physical (Δ=70 points) and emotional scale (Δ=63 points) of the SF-36. Fatigue did not occur as an isolated symptom and was most highly correlated with musculoskeletal pain (r=0.511; P≤0.001) and muscular cramps (r=0.448; P≤0.001). Chronic fatigue is the major factor limiting HRQOL of CML patients receiving imatinib.

The impact of comorbidity on health-related quality of life in elderly patients with chronic myeloid leukemia

“…In our previous study [29] analyzing the whole sample, we found that fatigue was independently associated with all HRQOL physical and mental health domains of the SF-36. In this analysis, specifically investigating the role of comorbidity on HRQOL in the elderly sub-population (i.e., with a substantial higher number of comorbid conditions), we found that comorbidity was associated with both HRQOL and fatigue.…”

Discontinuation of tyrosine kinase inhibitors in chronic myeloid leukemia: when is this a safe option to consider?

“…With the high cost of tyrosine kinase inhibitor (TKI) therapy and the diminished quality of life noted over time in a significant proportion of patients with CML, the idea of a holiday from therapy or eliminating the need for lifelong therapy is appealing to many. [8][9][10][11] The question then becomes, is it safe?…”

Chronic myeloid leukemia: reminiscences and dreams

“…The longer-term follow-up studies do, however, indicate an adverse effect on the quality of life, particularly in younger female patients, and other unique effects, such as effects on bone growth and mineralization and gynecomastia. [84][85][86] Finally, although there appears to be no definitive evidence to suggest exposure to imatinib increases the risk of developing a second malignancy, it is reasonable for specialists to remain cautious and follow patients on long-term treatment carefully. 87 …”