Study Finds QOL Lags in Patients With CLL, Even Before Treatment

Many patients diagnosed with chronic lymphocytic leukemia (CLL) do not require immediate treatment, but a new study suggests that simply “watching and waiting” can have a significantly negative impact on those patients’ quality of life.

About two-thirds of patients are diagnosed with CLL at a sufficiently early stage that they can be put on “watch and wait” status (W&W), during which they are monitored without proceeding with a specific treatment. In India, where the new study took place, CLL makes up only about 5% of all leukemia cases, a lower rate than the one-third rate found in wealthier countries. However, Indians with CLL tend to be diagnosed at an earlier age and tend to have a higher morbidity burden.

Analyzing these data, corresponding author Deepesh P. Lad, MD, of the Postgraduate Institute of Medical Education and Research, in Chandigarh, India, and colleagues decided to look at the health-related quality of life (HR-QoL) of patients in India who are diagnosed with CLL. Their findings are published in the European Journal of Hematology.

The team created a pool of 127 patients (92 of whom were male) with CLL and age-matched them with 100 controls (split evenly between sexes). The study enrollees answered the EORTC QLQ-C30 and QLQ-CLL17 questionnaires.

The study showed that the patients with CLL had impaired QoL compared with the control group, regardless of whether they were in W&W status or in treatment. QoL did not differ based on age or gender.

Patients with lower socioeconomic status reported higher rates of financial difficulty. Patients receiving chemoimmunotherapy (CIT) had worse overall health compared to patients on W&W. Those who were taking ibrutinib (Imbruvica) reported less fear about their health and functioning compared to patients receiving CIT.

Lad and colleagues wrote that their study shows the significant toll taken on patients in W&W status, despite the fact their status is by definition an indication that their disease has not yet advanced far enough to warrant treatment. These patients scored more poorly on functioning scales in the questionnaire when compared to healthy controls.

“They also had high scores for fatigue, pain, insomnia, appetite loss, financial difficulties, and global health status,” Lad and colleagues said. “The CLL-specific symptom scores were also significantly higher.”

The authors said it is important that clinicians address these QoL issues when possible, including by linking patients with medical social workers.

The study also raised the question of whether prognosis should be discussed in detail when patients are on W&W status. Some clinicians wait until disease progression to have such discussions. However, Lad and colleagues said they begin such discussions right away, listing the pros and cons of various options.

“We feel this strategy does not negatively impact QoL but positively reinforces the patient’s belief in the treating physician, even during the W&W period,” they wrote.

Lad and colleagues conceded that their study was limited in size, and was a single-center study. They also said a prospective study that followed patients through the progression of the disease might ultimately yield stronger results.

However, they said they hope these results become meaningful factors in future clinical trials and in the treatment decisions made by physicians and patients with early-stage CLL.

Reference

Youron P, Singh C, Jindal N, et al. Quality of life in patients of chronic lymphocytic leukemia using the EORTC QLQ-C30 and QLQ-CLL17 questionnaire. Eur J Haematol. Published online August 3, 2020. doi:10.1111/ejh.13503