Lifestyle Factors Significantly Impact Survival Of Non-Hodgkin's Lymphoma Patients

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BlankLifestyle Factors Significantly Impact Survival Of Non-Hodgkin's Lymphoma

Patients

14 May 2010

A new study led by researchers from Mayo Clinic in collaboration with six other

U.S. institutions has found that patients with non-Hodgkin's lymphoma who

smoked, consumed alcohol or were obese before their cancer diagnosis had poorer

overall survival, compared to patients who did not have these risk factors. This

association held after accounting for clinical and demographic factors, and also

when considering only deaths due to this kind of lymphoma.

For example, non-Hodgkin's lymphoma patients with a 20-plus-year history of

smoking had a 76 percent higher risk of death compared to never smokers;

patients who consumed more than 43 grams of alcohol per week had a 55 percent

higher risk of death compared to nondrinkers; and obese patients (defined as a

body mass index of 30 or higher) had a 32 percent higher risk of death compared

to patients with normal weight for their height.

While smoking and obesity had already been found to increase the risk of

developing non-Hodgkin's lymphoma, this is the first U.S. study to look at their

role on survival after being diagnosed with non-Hodgkin's lymphoma, the

researchers say. For alcohol, they found that use was associated with poorer

survival, which is opposite of the effect for developing non-Hodgkin's lymphoma,

where alcohol appears to lower risk.

These findings, published in the March 30 online edition of Cancer, mirror

conclusions found in three smaller studies, according to the study's lead

investigator, Cerhan, M.D., Ph.D., a Mayo cancer epidemiologist. These are

the first data from North American patients, and the only study to

simultaneously look at all three lifestyle factors, he says.

" This now raises the hypothesis that changing these behaviors after diagnosis

might improve survival, but this needs to be tested in a clinical study, " he

says. " In the meantime, patients in active therapy should discuss any lifestyle

changes with their health care provider. Long-term survivors outside of therapy

should consider the general public health guidelines that recommend smoking

cessation, moderate or no alcohol use, and attaining a healthy weight. "

In this study, information from 1,286 non-Hodgkin's lymphoma patients was

collected from 1998 to 2000. Patients were identified from population-based

cancer registries in Michigan, Iowa, California, and Washington, and they were

interviewed shortly after diagnosis. Participants were asked to report their

height and weight the year before they were diagnosed, and half of the

participants also were asked information about use of alcohol and smoking

history.

Through 2007, 442 (34 percent) patients had died, including 144 of 420 patients

with diffuse large B-cell lymphoma and 93 of 328 of patients with follicular

lymphoma, the two most common non-Hodgkin's lymphoma subtypes.

Of the 471 patients who provided information about smoking history, 34 percent

were former smokers and 19 percent were current smokers at the time of

diagnosis. Researchers calculated that both former and current smoking in these

patients was associated with an approximately 50 percent higher risk of death.

Poorer survival also was linked to longer smoking duration and greater numbers

of cigarettes smoked per day.

But there was a piece of good news. " It is important to note that patients who

had quit smoking 20 years or more before diagnosis had no higher risk of death

than patients who had never smoked, " Dr. Cerhan says.

Of the 458 patients with data on alcohol use, 49 percent consumed alcohol one

year before diagnosis, and the median intake was 43.1 grams a week (about 3.3

cans of beer, 4.6 glasses of wine, or 2.7 shots of liquor weekly). Researchers

found a 55 percent increased risk of death among those who drank more than 43

grams a week compared to never drinkers. In contrast, patients who drank 43

grams or less a week had a risk of death similar to nondrinkers.

Dr. Cerhan notes that the association between drinking and survival is the

opposite of what was found for the development of non-Hodgkin's lymphoma. There,

alcohol use appears to lower risk of non-Hodgkin's lymphoma. " We don't know why

this is the case, but suggests alcohol may have different impacts on developing

versus surviving non-Hodgkin's lymphoma, and this warrants further research, " he

says.

Of the 1,189 who provided usable data about their height and weight, about 5

percent were underweight, 31 percent were normal weight, 39 percent were

overweight, and 26 percent were classified as obese. After adjusting for

clinical and demographic factors, obese patients had a 32 percent higher risk of

death compared to normal weight patients; the risk of death for overweight

patients was similar to that for normal weight patients.

Even given these results for lifestyle factors, the strongest predictors of

outcome in non-Hodgkin's lymphoma remain age and clinical measures that include

issues such as cancer stage, the number of lymph nodes that are affected, and

certain biochemical measurements, Dr. Cerhan says.

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