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1654 Beyond Mortality: Health-Related Quality of Life in Adolescent and Young Adult Patients with Lymphoma: A Longitudinal Study

Program: Oral and Poster Abstracts
Session: 905. Outcomes Research—Malignant Conditions (Lymphoid Disease): Poster I
Hematology Disease Topics & Pathways:
Young Adult, Study Population
Saturday, December 5, 2020, 7:00 AM-3:30 PM

Carla Casulo, MD1, Tanzy Love, PhD2*, Xiang Lu, PhD2*, Melissa C. Larson, MS3*, Kathleen J. Yost, PhD4*, Allison C. Rosenthal, D.O.5, Thomas M. Habermann, MD6, Brian K. Link, MD7, Andrew L. Feldman, MD8, Susan L. Slager, PhD4*, Jonathon B. Cohen, MD, MS9, Christopher Flowers, MD, MS10, James R. Cerhan, MD, PhD6 and Carrie A. Thompson, MD6

1Department of Medicine , Hematology/Oncology, James P. Wilmot Cancer Center, Rochester, NY
2Department of Biostatistics, University of Rochester, Rochester, NY
3Bistatistics, Mayo Clinic, Rochester, MN
4Department of Health Sciences Research, Mayo Clinic, Rochester, MN
5Mayo Clinic, Phoenix, AZ
6Division of Hematology, Mayo Clinic, Rochester, MN
7Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
8Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
9Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
10MD Anderson Cancer Center, Houston, TX

Introduction: Lymphoma is the most common cancer among adolescents and young adults (AYAs). We examined changes in health-related quality of life (HRQoL) and its predictors in AYA patients (pts).

Patients and Methods: We identified AYA pts (aged 18-39) enrolled 2002-2015 in a prospective cohort of pts with newly diagnosed lymphoma from the University of Iowa and Mayo Clinic Molecular Epidemiology Resource, part of the Lymphoma Epidemiology of Outcomes cohort. Enrollment could occur prior to or after initiation of treatment. We measured HRQoL using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire at baseline, 12, and 24 months. FACT-G yields five HRQoL domain scores: emotional well-being (EWB), functional WB (FWB), physical WB (PWB), social/family WB (SFWB), and total FACT-G score (a sum of the domains). Pts completing <80% of the FACT-G questions were excluded.

Linear mixed models with random subject intercepts estimated changes in FACT-G scores from baseline. The covariates in multivariate analysis were lymphoma subtype, stage, and treatment. Interaction effects between treatment (chemotherapy and/or radiation) and subtype were added to the model. We calculated effect sizes (ES) for the magnitude of mean change scores: 0.2, 0.5, and 0.8 were considered small, medium, and large ESs, respectively. Only ESs for mean score differences with p<0.05 are reported.

Results: We identified 467 pts; median age at diagnosis was 30 years, median follow up was 5.9 years. 53% of pts completed the baseline FACT-G assessment pre-treatment, 47% completed after treatment began. Pts assessed after treatment initiation had lower baseline total FACT-G (ES -0.25), FWB (ES -0.27), and PWB scores (-0.46); but baseline EWB was higher in pts assessed prior to treatment (ES 0.20). There was no association between HRQoL scores at baseline or over time and lymphoma subtype, stage, or treatment type, or interactions.

Total FACT-G scores modestly improved over time, ES 0.32 at 1 year and ES 0.45 at 2 years after enrollment. EWB, FWB, and PWB also improved over time (ES 0.36, 0.44, 0.30 at 1 year; and 0.49, 0.56, 0.38 at 2 years, respectively). SFWB scores slightly worsened over time (ES -0.24 at 1 year and -0.12 at 2 years).

Conclusions: AYA pts with lymphoma had higher baseline total FACT-G scores, FWB and PWB prior to therapy initiation compared to after initiation. HRQoL improved from diagnosis through the first 2 years after diagnosis, except for SFWB. Neither stage, lymphoma subtype, nor treatment type affected change in HRQoL. The lack of improvement in SFWB suggests social interventions and future studies should examine factors impacting SFWB in AYA pts.

Disclosures: Cohen: Janssen, Adicet, Astra Zeneca, Genentech, Aptitude Health, Cellectar, Kite/Gilead, Loxo: Consultancy; Genentech, BMS, Novartis, LAM, BioInvent, LRF, ASH, Astra Zeneca, Seattle Genetics: Research Funding. Flowers: Leukemia and Lymphoma Society: Membership on an entity's Board of Directors or advisory committees; National Cancer Institute: Research Funding; AbbVie: Consultancy, Research Funding; Cancer Prevention and Research Institute of Texas: Research Funding; Eastern Cooperative Oncology Group: Research Funding; Burroughs Wellcome Fund: Research Funding; Kite: Research Funding; V Foundation: Research Funding; TG Therapeutics: Research Funding; Millennium/Takeda: Consultancy, Research Funding; Acerta: Research Funding; Spectrum: Consultancy; Pharmacyclics/Janssen: Consultancy; Karyopharm: Consultancy; OptumRx: Consultancy; Gilead: Consultancy, Research Funding; Genentech, Inc./F. Hoffmann-La Roche Ltd: Consultancy, Research Funding; Denovo Biopharma: Consultancy; Celgene: Consultancy, Research Funding; BeiGene: Consultancy; Bayer: Consultancy. Cerhan: BMS/Celgene: Research Funding; NanoString: Research Funding.

*signifies non-member of ASH