Hodgkin’s Lymphoma: An Environmental Scan
Table of Contents
3.13 Consequences of Treatments: Late Effects
As a result of their previous cancer treatments, there is a risk of several morbidity issues and death for individuals who have undergone treatment for HL. Further complications are the result of the toxicity of chemotherapy and radiation. An increased risk exists for heart and lung disease, thyroid function problems, sterility and other health issues along with a risk of the development of secondary cancers (Hodgson et al. 2010) (Küppers, Yahalom, and Josting 2006). In fact, among older adults, who were male and particularly among men who underwent ABVD chemotherapy, cardiac complications as a result of the toxicity of treatment is a significant late effect (Myrehaug et al. 2008). A large population study published in 2008 examined mortality rates of patients previously diagnosed and treated for HL compared to the general population between 1967 and 2003. Results showed that there was an increased risk of mortality among the HL patient group compared to the general public and the progression of HL continued as the leading cause of death. However, over time a clear pattern of decreasing deaths due to infections and toxicity of treatments was noted. Cardiac complications and the appearance of secondary tumors remained among the patient group (Provencio et al. 2008). Although having complications later in life as a result of treatment for Hodgkin’s Lymphoma, patients are improving and will continue with the advancement of personalized therapies and targeted treatments to reduce the toxicity of conventional treatments. On-going screening during the post-treatment time periods, such as breast cancer screening for women who have previously undergone chemotherapy or radiation treatments, is essential as are a number of surveillance procedures (Hodgson et al. 2010).
Despite the call from both researchers and clinicians for guidelines surrounding follow-up care for HL patients, there is no consensus and/or uniformly followed guidelines for use. Research suggests that follow-up for HL survivors is poor, too many patients are not followed up with systematic protocols regarding after care (Alfred Ian Lee et al. 2010). For example, there is disagreement about what types of diagnostic/screening tests to use including no consensus around particular imaging technology to use during the follow-up period (Alfred Ian Lee et al. 2010). One such study in the United States found no difference in surveillance of HL survivors using radiography and suggests that CT scans are both cost-effective and adequate with respect to imagine techniques (Alfred Ian Lee et al. 2010). Furthermore there is no protocol for whether or not the oncologist or primary care physician is best suited for on-going surveillance.