Reviewed Studies

Study	Purpose	Domains	Sample	Design and Instruments	Findings
Alibhai et al., 2012	To determine recruitment, retention, and ability of patients with acute leukemia undergoing induction chemotherapy to participate in an individualized exercise intervention during hospitalization, provide efficacy estimates on physical fitness outcome measures, and examine the safety of the exercise program	Symptoms Function QOL	35 patients with acute leukemia in Canada (18 were younger than age 60, 17 were age 60 and older); 46% were male and 74% were Caucasian.	Non-randomized, prospective, exercise intervention EORTC QLQ-C30 FACT-F HADS VAS	Confirmed feasibility and safety of a carefully designed and controlled intervention in both older and younger patients with acute leukemia. Most commonly reported reason for not participating in daily exercise was fatigue.
	To provide estimates of the effects of exercise on QOL and fatigue, and to understand the impact of exercise on acute leukemia treatment tolerability, including length of stay in the hospital, development of sepsis, ICU admission, and delay in subsequent chemotherapy
Alibhai, Leach, Kermalli, et al., 2007	To examine QOL and self-reported functional status over a six-month period in older adults with newly diagnosed acute leukemia who were being man-aged with either intensive chemotherapy or less-aggressive approaches	Symptoms Function QOL	65 patients in Canada with acute leukemia with a mean age of 72.1 years; 71% were male and ethnicity was not reported.	Prospective, longitudinal EORTC QLQ-C30 ESAS FACT-F GDS	At baseline, functional status was high but QOL was negatively affected in global health and most QOL domains. Over time, QOL remained stable or improved in most patients and was generally similar between intensive chemotherapy and non-intensive chemotherapy groups. Basic ADL scores did not change over time, whereas instrumental ADL scores declined slightly regardless of treatment. Receiving intensive chemotherapy does not appear to lead to worse QOL or functional status than more palliative approaches.
Alibhai, Leach, Kowiger, et al., 2007	To characterize the prevalence and severity of fatigue, correlations between fatigue and QOL and functional status, and examine correlations between fatigue and potential sociodemographic and clinical variables	Symptoms Function QOL	65 patients in Canada with acute leukemia with a mean age of 72.1 years; 71% were male and ethnicity was not reported.	Prospective, longitudinal EORTC QLQ-C30 FACT-F GDS	Fatigue scores had moderate-to-strong correlations with global health and all five QOL domains; strongest correlations were with global health and physical function. Moderate-to-strong correlations between fatigue scores and depression scores were noted. Fatigue improved slightly over time in intensive chemotherapy and non-intensive chemotherapy groups.
Battaglini et al., 2009	To examine the feasibility of administering an in-hospital exercise program to patients with acute leukemia undergoing chemotherapy	Symptoms Function QOL	10 patients with acute leukemia in the United States ranging in age from 18–55 years; 70% were male and ethnicity was not reported.	Non-randomized, controlled trial exercise intervention CES-D FACT-G RPFS	Significant improvements were noted in cardiorespiratory endurance (p = 0.009; baseline, 8.9 ± 8.8 minutes; postexercise intervention, 17 ± 14.3 minutes). Significant reductions in total fatigue scores also were noted (p = 0.009; baseline, 4.6 ± 1.7; postexercise intervention, 1.8 ± 1.6). Depression scores were reduced as well (p = 0.023; baseline, 19 ± 11.5; postexercise intervention, 12 ± 8.2). Marginally significant decrease was seen in interleukin-6 (p = 0.059), with no significant changes in interleukin-10 (p = 0.223) or interferon-γ (p = 0.882).
Efficace et al., 2012	To investigate whether baseline patient-reported symptom severity independently predicted overall survival in a heterogeneous hematologic population, mainly with advanced disease, followed up in a prospective study	Symptoms	119 patients in Italy with various cancers and a mean age of 70 years; 36% were male and ethnicity was not reported.	Prospective, observational MDASI	The median survival of the entire cohort was 4.8 months (range = 0–28 months). The MDASI was completed at baseline by 91% of patients. The final multivariate model retained two parameters as independent prognostic factors for survival: clinical prognostic group and patient’s self-reported severity of drowsiness. HRs were found for curable versus terminal, 0.055 (95% CI [0.022, 0.136], p < 0.001), and for advanced versus terminal, 0.193 (95% CI [0.103, 0.362], p < 0.001). Patient’s self-reported severity of drowsiness independently predicted survival with an HR of 1.801 (95% CI [1.044, 3.107], p = 0.033). Additional sensitivity analysis confirmed the independent prognostic value of variables identified in this study.
Forjaz et al., 2001	To investigate health-related QOL differences between 98 Portuguese and 109 American outpatients with hematologic malignancies	Symptoms Health-related QOL	98 Portuguese (51% male with a mean age of 55 years) and 108 American (53% male with a mean age of 49 years) patients with various cancer types.	Prospective, cross-sectional FLIC SF-36®	Portuguese patients reported better physical functioning, less pain, more vitality, better social functioning, and better general QOL than American patients.
Klepin et al., 2011	To test feasibility and use of a bedside GA to detect impairment in multiple geriatric domains in older adults initiating chemotherapy for acute leukemia	Symptoms Function QOL	54 patients with acute leukemia in the United States, with a mean age of 70.8 (52% aged 60–69 and 35% aged 70–79); 59% were male and 96% were Caucasian.	Prospective, observational cohort study CES-D DT	93% completed the entire GA; the mean time was 44 minutes (SD = 14). Impairments detected included cognitive (32%), depression (39%), distress (54%), impairments in ADLs (48%), impaired physical performance (54%), and comorbidities (46%).
Kornblith et al., 1998	To compare long-term psychosocial adaptation of Hodgkin disease and acute leukemia survivors	Symptoms	273 patients with Hodgkin disease (mean age of 29.6 years [SD = 28]) and 206 with acute leukemia (mean age of 36.4 years [SD = 34]) in the United States.	Prospective, cross-sectional, telephone interviews BSI PAIS-SR	Hodgkin disease survivors’ risk of having a high distress score on the BSI was almost twice that of acute leukemia survivors (OR = 1.9), with 21% of Hodgkin versus 14% of acute leukemia survivors (p < 0.05) having scores that were 1.5 SDs above the norm, suggestive of a possible psychiatric disorder. Hodgkin survivors reported greater fatigue (POMS fatigue, p = 0.01, and vigor, p = 0.001, subscales), greater conditioned CINV (p < 0.05), greater impact of cancer on their family life (p = 0.004), and poorer sexual functioning (p = 0.0001) than acute leukemia survivors.
Mohamedali et al., 2012	To investigate the short-term effects of intensive chemotherapy on QOL, fatigue, and physical function in patients with acute leukemia; and to compare changes in physical function, QOL, and fatigue in older (aged 60 years and older) and younger (aged 18–59 years) patients	Symptoms Function QOL	103 patients with acute leukemia in Canada; 65 patients were younger than age 60 (68% male) and 38 were age 60 and older (34% male); 68% in the younger group and 82% in the older group were Caucasian, respectively.	Prospective, longitudinal cohort EORTC QLQ-C30 ESAS FACT-F	Both QOL and physical function were worse than normative data. QOL was fairly stable over time and similar in both age groups, whereas physical function generally improved over time, but the improvement was somewhat greater in younger compared to older adults. Compared to younger adults, older adults tolerate intensive chemotherapy quite well from QOL and physical function perspectives.
Montgomery et al., 2002	To evaluate the clinical usefulness of a novel QOL measure, the SEIQOL–Direct Weighting, in a sample of patients with either leukemia or lymphoma	QOL	51 patients with various cancers in the United Kingdom with a mean age of 54 years; 71% were male and ethnicity was not reported.	Prospective, cross-sectional HADS SEIQOL	The inverse relationship between QOL (SEIQOL score) and psychological distress (depression and anxiety) as measured by total HADS score was confirmed. The domain of “family” was nominated most frequently (82%) as an important area from which QOL is derived; this domain was also weighted by 58% of patients as first or second in importance. The fact that “health,” as a domain, was not, in this sample, the most important determinant of QOL was an interesting finding which reinforces the value of using an instrument which does not impose an external, clinician-derived set of values. The association between total mean HADS scores and SEIQOL scores suggests that depression and anxiety is an important risk factor for a diminished QOL experience, but a causal relationship cannot be established from the data.
Montgomery et al., 2003	To examine relationships between coping style, QOL, and psychological distress in a sample of patients with leukemia and lymphoma	Symptoms QOL	51 patients with various cancer in the United Kingdom with a mean age of 54 years; 71% were male and ethnicity was not reported.	Prospective, cross-sectional HADS MAC SEIQOL	51% with moderate distress; 14% with severe distress; 27% identified as having adjusted poorly to their diagnosis and having low scores on the Fighting Spirit subscale of the MAC and high scores on the Hopeless/Helpless subscale. Those with a worse coping style were most likely to suffer from severe psychological distress.
Pearce et al., 2012	To determine if inpatients receive spiritual care consistent with their needs. When inconsistent, are there deleterious effects on patient outcomes?	Symptoms QOL	150 patients with various cancers from the United States with a mean age of 59 years; 54% were male and ethnicity was not reported.	Prospective, cross-sectional CES-D FACT-G FACT-Sp	91% had spiritual needs, and the majority desired and received spiritual care from their healthcare providers. Those who received less spiritual care than desired reported more depressive symptoms [adjusted β (SE) 0–1.2 (0.47), p = 0.013] and less meaning and peace [adjusted β (SE) 0–2.37 (1.15), p = 0.042].
Persson et al., 2001	To investigate QOL and sense of coherence for patients with acute leukemia and malignant lymphoma at the start of treatment and during two years. The secondary aim was to compare questionnaires responses with patients’ statements in open-ended interviews.	Symptoms QOL	16 patients with various cancers from Sweden with a mean age of 57 years.	Prospective, longitudinal EORTC QLQ-C30 LGC	QOL at start of treatment was reduced mostly with role and social functioning and by presence of fatigue, dyspnea, and sleep disturbances; patients who relapsed at the start of treatment had a significantly more reduced QOL in most functional aspects and a higher level for most symptoms compared to those who did not relapse. Patients with acute leukemia were more affected with social functioning and global QOL and had a significantly more positive development in physical functioning and global QOL.
Persson et al., 2004	To narrate the lived experience of falling ill, being in treatment, and life following this event	–	18 patients with various cancers from Sweden with a mean age of 58 years; 44% were male and ethnicity was not reported.	Interview	(a) Believed in life, fought for it, and came through stronger; (b) life went on, adapted and found a balance in the new life; and (c) life was over, felt out of control, and lost belief in life
Schumacher et al., 1998	To evaluate QOL in patients with acute leukemia treated according to the protocol of the German AML Cooperative Group	Symptoms QOL	28 patients with acute leukemia in Germany. The mean age was 46 years; 43% were male and ethnicity was not reported.	Prospective, longitudinal EORTC QLQ-C30	Although most patients with acute leukemia eventually relapse, the evaluation of QOL in patients undergoing treatment shows that subjective benefit outweighs the adverse effects of antileukemic therapy.
Stalfelt, 1994	To explore QOL in patients with acute leukemia during the course of their disease	Function QOL	27 patients with acute leukemia from Sweden; mean age was 46.9 years (range = 18–74) and 51% were male. Ethnicity was not reported.	Prospective, longitudinal LIP	Induction treatment entailed physical and psychological distress with decreased QOL but with continued ability to enjoy various leisure activities. Patients who survived experienced a change of attitude with regard to what was important in their lives. They reverted to their previous lifestyle within two years.
Yau et al., 1991	To evaluate long-term outcomes and QOL in patients discharged from the hospital following intensive care for life-threatening medical complications of hematologic malignancy, identify factors that might influence long-term prognosis in such cases	Function QOL	92 patients with various cancers in London, England; 63% were male and age and ethnicity were not reported.	Retrospective, longitudinal HADS PQOL	QOL of six of the seven long-term survivors is good, while that of the other is acceptable. None of the patients reported any increased limitation of their daily activities, five had returned to full-time employment, and all seven stated that they would be willing to undergo intensive care again under the same circumstances.

ADL—activities of daily living; BSI—Beck Symptom Inventory; CES-D—Center for Epidemiologic Studies Depression; CI—confidence interval; CINV—chemotherapy-induced nausea and vomiting; DT—Distress Thermometer; ESAS—Edmonton Symptom Assessment Scale; EORTC QLQ-C30—European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire–Core 30; FACT-F—Functional Assessment of Cancer Therapy–Fatigue; FACT-G—Functional Assessment of Cancer Therapy–General; FACT-Sp—Functional Assessment of Cancer Therapy–Spiritual; FLIC—Functional Living Index-Cancer; GA—geriatric assessment; GDS—Geriatric Depression Scale; HADS—Hospital Anxiety and Depression Scale; HR—hazard ratio; ICU—intensive care unit; LIP—Life Ingredient Profile; LGC—Lund Gerontological Centre Generic Global QOL; MAC—Mental Adjustment to Cancer; MDASI—MD Anderson Symptom Inventory; PAIS-SR—Psychosocial Adjustment to Illness Scale–Self Report; PQOL—Perceived Quality of Life; QOL—quality of life; RPFS—Revised Piper Fatigue Scale; SEIQOL—Schedule for the Evaluation of Individual Quality of Life; VAS—Visual Analog Scale