Annals of Hematology

, Volume 98, Issue 10, pp 2357–2366 | Cite as

Comparison of quality of life and health behaviors in survivors of acute leukemia and the general population

  • Koung Jin Suh
  • Dong-Yeop Shin
  • Inho Kim
  • Sung-Soo Yoon
  • Jeong-Ok Lee
  • Soo-Mee Bang
  • Ja Min Byun
  • Ki Hwan Kim
  • Jin Hyun Park
  • Sang Min Park
  • Youngae Kim
  • Young Ho Yun
  • Youngil KohEmail author
Original Article


We aimed to compare the health-related quality of life and health behaviors of acute leukemia (AL) survivors with that of the general population from two cohorts. AL survivors (n = 149) completed a set of questionnaires to evaluate quality of life, mental status, and health behaviors. AL survivors had more physical and mental difficulties (problems with usual activities, 15% vs. 5%, p < 0.001; anxiety or depression, 24% vs. 9%, p < 0.001; pain, 35% vs. 20%, p = 0.002) and more financial difficulties (p < 0.001) than the general population. Survivors who received stem cell transplantation (SCT) had significantly worse problems with role functioning, fatigue, pain, dyspnea, and insomnia, and had higher depression scores than chemotherapy group (p = 0.024). In terms of health behaviors, AL survivors had lower rates of smoking and drinking and higher influenza vaccination rates than the general population. However, only 17% of survivors had been recommended to receive screening for other cancers from health-care providers, and 67% thought their risk for other cancers was equal or lower than that of the general population. Cancer screening rates were even lower in the SCT group than in the chemotherapy group (p = 0.041). Our study indicates that clinicians should establish more appropriate survivorship care plans.


Health-related quality of life Acute leukemia Hematopoietic stem cell transplantation 



This study was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI14C1277).

Compliance with ethical standards

The institutional review boards of the participating institutions approved the study, and informed consent was obtained from all subjects.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

277_2019_3760_MOESM1_ESM.docx (19 kb)
ESM 1 (DOCX 18 kb)


  1. 1.
    Bassan R, Hoelzer D (2011) Modern therapy of acute lymphoblastic leukemia. J Clin Oncol 29:532–543. CrossRefGoogle Scholar
  2. 2.
    Estey E, Döhner H (2006) Acute myeloid leukaemia. Lancet 368:1894–1907. CrossRefGoogle Scholar
  3. 3.
    Zittoun R, Suciu S, Watson M, Solbu G, Muus P, Mandelli F, Stryckmans P, Peetermans M, Thaler J, Resegotti L, Dardenne M, Willemze R (1997) Quality of life in patients with acute myelogenous leukemia in prolonged first complete remission after bone marrow transplantation (allogeneic or autologous) or chemotherapy: a cross-sectional study of the EORTC-GIMEMA AML 8A trial. Bone Marrow Transplant 20:307–315. CrossRefGoogle Scholar
  4. 4.
    Schumacher A, Kessler T, Büchner T, Wewers D, van de Loo J (1998) Quality of life in adult patients with acute myeloid leukemia receiving intensive and prolonged chemotherapy—a longitudinal study. Leukemia 12:586–592CrossRefGoogle Scholar
  5. 5.
    Hjermstad M, Holte H, Evensen S, Fayers PM, Kaasa S (1999) Do patients who are treated with stem cell transplantation have a health-related quality of life comparable to the general population after 1 year? Bone Marrow Transplant 24:911–918. CrossRefGoogle Scholar
  6. 6.
    Hjermstad MJ, Evensen SA, Kvaløy SO, Fayers PM, Kaasa S (1999) Health-related quality of life 1 year after allogeneic or autologous stem-cell transplantation: a prospective study. J Clin Oncol 17:706–718. CrossRefGoogle Scholar
  7. 7.
    Broers S, Kaptein AA, Le Cessie S et al (2000) Psychological functioning and quality of life following bone marrow transplantation: a 3-year follow-up study. J Psychosom Res 48:11–21CrossRefGoogle Scholar
  8. 8.
    Lee SJ, Fairclough D, Parsons SK, Soiffer RJ, Fisher DC, Schlossman RL, Antin JH, Weeks JC (2001) Recovery after stem-cell transplantation for hematologic diseases. J Clin Oncol 19:242–252. CrossRefGoogle Scholar
  9. 9.
    Heinonen H, Volin L, Uutela A, Zevon M, Barrick C, Ruutu T (2001) Quality of life and factors related to perceived satisfaction with quality of life after allogeneic bone marrow transplantation. Ann Hematol 80:137–143CrossRefGoogle Scholar
  10. 10.
    Edman L, Larsen J, Hägglund H, Gardulf A (2001) Health-related quality of life, symptom distress and sense of coherence in adult survivors of allogeneic stem-cell transplantation. Eur J Cancer Care (Engl) 10:124–130CrossRefGoogle Scholar
  11. 11.
    Syrjala KL, Langer SL, Abrams JR, Storer B, Sanders JE, Flowers ME, Martin PJ (2004) Recovery and long-term function after hematopoietic cell transplantation for leukemia or lymphoma. JAMA 291:2335–2343. CrossRefGoogle Scholar
  12. 12.
    Hjermstad MJ, Knobel H, Brinch L, Fayers PM, Loge JH, Holte H, Kaasa S (2004) A prospective study of health-related quality of life, fatigue, anxiety and depression 3-5 years after stem cell transplantation. Bone Marrow Transplant 34:257–266. CrossRefGoogle Scholar
  13. 13.
    Andrykowski MA, Bishop MM, Hahn EA, Cella DF, Beaumont JL, Brady MJ, Horowitz MM, Sobocinski KA, Rizzo JD, Wingard JR (2005) Long-term health-related quality of life, growth, and spiritual well-being after hematopoietic stem-cell transplantation. J Clin Oncol 23:599–608. CrossRefGoogle Scholar
  14. 14.
    Syrjala KL, Langer SL, Abrams JR, Storer BE, Martin PJ (2005) Late effects of hematopoietic cell transplantation among 10-year adult survivors compared with case-matched controls. J Clin Oncol 23:6596–6606. CrossRefGoogle Scholar
  15. 15.
    Kopp M, Holzner B, Meraner V, Sperner-Unterweger B, Kemmler G, Nguyen-van-Tam DP, Nachbaur D (2005) Quality of life in adult hematopoietic cell transplant patients at least 5 yr after treatment: a comparison with healthy controls. Eur J Haematol 74:304–308. CrossRefGoogle Scholar
  16. 16.
    Bevans MF, Marden S, Leidy NK, Soeken K, Cusack G, Rivera P, Mayberry H, Bishop MR, Childs R, Barrett AJ (2006) Health-related quality of life in patients receiving reduced-intensity conditioning allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 38:101–109. CrossRefGoogle Scholar
  17. 17.
    Messerer D, Engel J, Hasford J, Schaich M, Ehninger G, Sauerland C, Buchner T, Schumacher A, Krahl R, Niederwieser D, Krauter J, Ganser A, Creutzig U, Dohner H, Schlenk RF, for the German AML Intergroup (2008) Impact of different post-remission strategies on quality of life in patients with acute myeloid leukemia. Haematologica 93:826–833. CrossRefGoogle Scholar
  18. 18.
    Pidala J, Anasetti C, Jim H (2009) Quality of life after allogeneic hematopoietic cell transplantation. Blood 114:7–19. CrossRefGoogle Scholar
  19. 19.
    Andersson I, Ahlberg K, Stockelberg D, Brune M, Persson LO (2009) Health-related quality of life in patients undergoing allogeneic stem cell transplantation after reduced intensity conditioning versus myeloablative conditioning. Cancer Nurs 32:325–334. CrossRefGoogle Scholar
  20. 20.
    Gupta V, Panzarella T, Li L, Khan J, Sharma A, Lipton JH, Kuruvilla J, Messner H, Alibhai SMH (2012) A prospective study comparing the outcomes and health-related quality of life in adult patients with myeloid malignancies undergoing allogeneic transplantation using myeloablative or reduced-intensity conditioning. Biol Blood Marrow Transplant 18:113–124. CrossRefGoogle Scholar
  21. 21.
    Fayers P, Aaronson N, Bjordal K (2001) The EORTC QLQ-C30 scoring manual, ed 3. European Organization for Research and Treatment of Cancer, BrusselsGoogle Scholar
  22. 22.
    Brooks R (1996) EuroQol: the current state of play. Health Policy Amst Neth 37:53–72CrossRefGoogle Scholar
  23. 23.
    Kim M-H, Cho Y-S, Uhm W-S, Kim S, Bae SC (2005) Cross-cultural adaptation and validation of the Korean version of the EQ-5D in patients with rheumatic diseases. Qual Life Res 14:1401–1406CrossRefGoogle Scholar
  24. 24.
    Yun YH, Park YS, Lee ES, Bang SM, Heo DS, Park SY, You CH, West K (2004) Validation of the Korean version of the EORTC QLQ-C30. Qual Life Res 13:863–868. CrossRefGoogle Scholar
  25. 25.
    Snaith RP (2003) The hospital anxiety and depression scale. Health Qual Life Outcomes 1:29. CrossRefGoogle Scholar
  26. 26.
    Mendoza TR, Wang XS, Cleeland CS, Morrissey M, Johnson BA, Wendt JK, Huber SL (1999) The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer 85:1186–1196CrossRefGoogle Scholar
  27. 27.
    Frank SH, Zyzanski SJ (1988) Stress in the clinical setting: the Brief Encounter Psychosocial Instrument. J Fam Pract 26:533–539Google Scholar
  28. 28.
    Oh SM, Min KJ, Park DB (1999) A study on the standardization of the hospital anxiety and depression scale for Koreans: a comparison of normal, depressed and anxious groups. J Korean Neuropsychiatr Assoc 38:289–296Google Scholar
  29. 29.
    Yun YH, Wang XS, Lee JS, Roh JW, Lee CG, Lee WS, Lee KS, Bang SM, Mendoza TR, Cleeland CS (2005) Validation study of the Korean version of the brief fatigue inventory. J Pain Symptom Manag 29:165–172. CrossRefGoogle Scholar
  30. 30.
    Busby DM, Christensen C, Crane DR, Larson JH (1995) A revision of the dyadic adjustment scale for use with distressed and nondistressed couples: construct hierarchy and multidimensional scales. J Marital Fam Ther 21:289–308. CrossRefGoogle Scholar
  31. 31.
    Cho H, Choi SM, Oh HJ, Kwon JH (2011) Validity of the short forms of the Korean dyadic adjustment scale. Korean J Couns Psychother 23:655–670Google Scholar
  32. 32.
    Smilkstein G, Ashworth C, Montano D (1982) Validity and reliability of the family APGAR as a test of family function. J Fam Pract 15:303–311Google Scholar
  33. 33.
    Suh KJ, Kim I, Lim J, Ha H, Park S, Koh Y, Yoon SS, Park S (2015) Total costs and clinical outcome of hematopoietic stem cell transplantation in adults with leukemia: comparison between reduced-intensity and myeloablative conditioning. Clin Transpl 29:124–133. CrossRefGoogle Scholar
  34. 34.
    Ghimire KB, Shah BK (2014) Second primary malignancies in adult acute myeloid leukemia—a US population-based study. Anticancer Res 34:3855–3859Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Koung Jin Suh
    • 1
  • Dong-Yeop Shin
    • 2
  • Inho Kim
    • 2
    • 3
  • Sung-Soo Yoon
    • 2
    • 3
  • Jeong-Ok Lee
    • 1
  • Soo-Mee Bang
    • 1
  • Ja Min Byun
    • 4
  • Ki Hwan Kim
    • 4
  • Jin Hyun Park
    • 4
  • Sang Min Park
    • 5
  • Youngae Kim
    • 6
  • Young Ho Yun
    • 5
  • Youngil Koh
    • 2
    • 3
    • 7
    Email author
  1. 1.Department of Internal Medicine, Seoul National University Bundang HospitalSeoul National University College of MedicineSeongnamSouth Korea
  2. 2.Department of Internal Medicine, Seoul National University HospitalSeoul National University College of MedicineSeoulSouth Korea
  3. 3.Cancer Research InstituteSeoul National UniversitySeoulSouth Korea
  4. 4.Department of Internal Medicine, Seoul National University Boramae Medical CenterSeoul National University College of MedicineSeoulSouth Korea
  5. 5.Department of Family Medicine, Seoul National University HospitalSeoul National University College of MedicineSeoulSouth Korea
  6. 6.Division of Cancer Management Policy, National Cancer Control InstituteNational Cancer CenterGoyangSouth Korea
  7. 7.Biomedical Research InstituteSeoul National University HospitalSeoulSouth Korea

Personalised recommendations