Burden

As with all types of cancer and their associated treatments, CLL may affect the physical, psychological, social and functional well-being of patients, i.e. the patient’s health related quality of life (HRQoL) (Pashos et al., 2013). There is relatively little data regarding the effects of CLL on patients’ quality of life (QoL) but one national study determined that physical, social/family, functional and overall QoL scores were similar to published population norms. However, emotional well-being scores for CLL patients were significantly much lower than both those of the general population and those of patients with other types of cancer. Older age, greater fatigue, severity of comorbidities and current treatments were associated with lower QoL for patients with CLL (Holtzer-Goor et al., 2015).

A further study looked at HRQoL aspects according to gender differences for patients in the US. Compared to men, at baseline women had significantly worse fatigue, pain/discomfort, anxiety/depression and physical HRQoL but better social/family HRQoL. Many HRQoL measures were comparable between males and females. Recognition of such problems and differences may be useful for healthcare professionals in order to be able to address specific issues (Pashos et al., 2013).

The mortality rate for CLL in the UK in 2012 was 1.1 per 100,000 (CRUK, 2014). Five-year relative survival for patients with CLL has increased in both England and the US in recent years due to improvements in treatment. In the UK, up to 2010, the five-year relative survival rates were 71.4% for the 64–75 years age group, 56.0% for patients aged 75–84 years and 30.4% for those aged 80+ years. Increasing age has a negative impact on survival outcomes with improvements in survival being less pronounced or marginal for older patients compared to younger ones. In CLL the excess hazard ratio (EHR) for mortality increases after the age of 65 with an EHR of 9.44 (US) and 6.14 (England) for patients aged more than 85+ years compared to the 55–64 years age group (Pulte et al., 2015).