The course of self-perceived cognitive functioning among patients with lymphoma and the co-occurrence with fatigue and psychological distress

Abstract
Purpose
To investigate the proportion of patients with lymphoma with persistent clinically relevant cognitive impairment, and its relation to treatment, fatigue, and psychological distress.

Methods
Patients with diffuse-large-B-cell-lymphoma (DLBCL), follicular-lymphoma (FL), and chronic-lymphocytic-leukemia (CLL)/small-lymphocytic-lymphoma (SLL), diagnosed between 2004–2010 or 2015–2019, were followed up to 8 years post-diagnosis. Sociodemographic and clinical data were obtained from the Netherlands Cancer Registry and the Population-based HAematological Registry for Observational Studies. The EORTC QLQ-C30 was used to assess cognitive functioning and fatigue, and the HADS to assess psychological distress. Individual growth curve models were performed. Results were compared with an age- and sex-matched normative population.

Results
A total of 924 patients were included (70% response rate). Persistent cognitive impairment was twice as high in patients (30%) compared to the normative population (15%). Additionally, 74% of patients reported co-occurring symptoms of persistent fatigue and/or psychological distress. Patients with FL (− 23 points, p < 0.001) and CLL/SLL (− 10 points, p < 0.05) reported clinically relevant deterioration of cognitive functioning, as did the normative population (FLnorm − 5 points, DLBCLnorm − 4 points, both p < 0.05). Younger age, higher fatigue, and/or psychological distress at inclusion were associated with worse cognitive functioning (all p’s < 0.01). Treatment appeared less relevant.

Conclusion
Almost one-third of patients with lymphoma report persistent cognitive impairment, remaining present up to 8 years post-diagnosis. Early onset and co-occurrence of symptoms highlight the need for clinicians to discuss symptoms with patients early.

https://link.springer.com/article/10.1007/s11764-023-01458-2

 

Usually the case when you don't have any after having denied this issue for... ever. Even though: 15% Really? That's catastrophic.

You're supposed to do the work if you want results. Don't do the work? No results. Do the work? Eventually you get results.

They didn't do the work. Still aren't doing it. And somehow can't reach a valid conclusion. As if talking about something they don't understand is a valid solution to the problem here.

I'm really growing into the fact that the lack of market forces has been disastrous in medicine. They just don't have enough pressure to solve issues. Private healthcare has so many issues, but the lack of any market pressure, of any private motivations to achieve anything, is really showing its age. Something critical is missing here. And I'm not saying the solution is privatized healthcare, far from it. But there's something big missing and it's not going to fix itself.

 

The big thing missing is that there are no consequences for abject failure or even duty of care no real enforcement or regulatory bodies with sharp teeth .