Pruritus Is an Indicator for Quality of Life in Cutaneous T-Cell Lymphoma

Abstract

In cutaneous T-cell lymphoma (CTCL), chronic pruritus affects up to 94% of patients as a leading factor reducing quality of life (QoL). Traditional antipruritic medication does not show sufficient relief. Partly due to a lack of therapeutic options, pruritus is rarely assessed in a standardized manner within routine clinical practice. In this cross-sectional, single-institution study, we characterized CTCL-associated pruritus including perception, dynamics, and modifying factors. QoL was evaluated with the Dermatology Life Quality Index (DLQI) and EORTC core quality of life questionnaire (QLQ-C30). Patients with early-stage Mycosis fungoides (MF, n = 16), late-stage MF (n = 10) and Sézary syndrome (SS, n = 10), treated at the University Hospital of Zurich, completed all three questionnaires. 80.5% (n = 29/36) patients reported disease-associated pruritus worsening with stress (51.7%, n = 15/29), scratching (37.9%, n = 11/29), and sweating or exercise (31.0%, n = 9/29). DLQI was associated with CTCL-specific skin involvement (modified severity-weighted assessment tool, mSWAT) (ρ = 0.44, p < 0.01), worst experienced pruritus (ρ = 0.42, p = 0.04) and current perceived pruritus (ρ = 0.60, p < 0.01). Summarizing those three factors in a Pruritus-Score correlated strongly with DLQI (ρ = 0.71, p < 0.01), QLQ-C30 global health status (ρ = −0.71, p < 0.01) as well as fatigue (ρ = 0.50, p = 0.02). Our results confirm the relevance of pruritus in CTCL. The Pruritus-Score outperforms solely assessment of present pruritus in identifying patients who might experience related impairments in QoL. It quantifies this complex symptom in three factors that can be collected in clinical practice. This Pruritus-Score can support consideration of pharmaceutical and non-pharmaceutical approaches aimed at addressing reductions in quality of life and associated symptoms such as fatigue.