Risk-factors of the Health-related Quality of Life in Hodgkin Lymphoma Patients

Objective: Hodgkin lymphoma survivors are at risk of experiencing persistent impairmentsin their health-related quality of life (HRQoL). This study identifies risk factors anddevelops prediction models for HRQoL of Hodgkin lymphoma patients using longitudinaldata. Methods: Data from N = 4981 patients (HD13-15 trials) from the German HodgkinStudy Group was analyzed using supervised machine learning methods (forward stepwiseregression, the lasso, the all-pairs lasso, bagging, and boosting) to identify risk factors anddevelop prediction models for HRQoL. Assessed HRQoL domains were cancer-relatedfatigue, overall HRQoL, financial impact, employment status, as well as physical, cognitive,emotional, social, and role functioning. Results: The prediction models based on thevariable selection performed with the all-pairs lasso had the best model fit and predictionquality. The all-pairs lasso identified between 9 to 17 risk factors per outcome variable.The prediction models at diagnosis explained between 28% to 33% of the variability, themodels during treatment explained 22% to 46%, the models after treatment explained 21%to 44%, and the models one year after treatment explained 43% to 73%. Validation(HD16-18 trial data) showed that the prediction models from baseline to one year aftertreatment were able to explain between 15% to 75% of the variability of each HRQoLoutcome. Conclusions: This analysis reveals demographic, physical, medical, andpsychosocial risk factors for Hodgkin lymphoma patients’ HRQoL. The results contributeto a better understanding of the development of long-term reduced HRQoL andspecifically, persistent cancer-related fatigue. These results may inform the development ofmuch-needed targeted prevention measures.