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Cardiovascular side effects following treatment of Hodgkin’s lymphoma: comorbidity factors and a strategy for intervention
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
Uppsala universitet.
Lunds universitet.
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
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(English)Manuscript (preprint) (Other academic)
National Category
Cancer and Oncology
Research subject
Oncology
Identifiers
URN: urn:nbn:se:umu:diva-43271OAI: oai:DiVA.org:umu-43271DiVA: diva2:412678
Available from: 2011-04-26 Created: 2011-04-26 Last updated: 2011-04-29Bibliographically approved
In thesis
1. Long-term side effects after treatment of Hodgkin's lymphoma
Open this publication in new window or tab >>Long-term side effects after treatment of Hodgkin's lymphoma
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Long-term side effects associated with the treatment of Hodgkin’s lymphoma (HL) have frequently been reported during the last decades. Studies have shown increased mortality in HL survivors. Following Hodgkin’s lymphoma, second malignancies (SM) and cardiovascular disease (CVD) are the most common causes of death in individuals treated for HL. This study investigates the incidence of side effects such as SM, CVD and infections in a cohort diagnosed with HL in Sweden between 1965 and 1995. In addition, this study identifies covariate risk factors for late side effects in order to develop strategies that prevent morbidity and mortality in HL survivors.

Methods Using the Swedish Cancer Registry (SCR) at the National Board of Health and Welfare and the Multi-Generation Registry at Statistics (MGR) Sweden, we identified 6946 individuals diagnosed with HL between the years 1965 and 1995, and their first degree relatives (FDR) (n=17 858). In addition we identified the malignancies and inpatient care for CVD and infections for the HL cohort and their FDR. The standard incidence ratio (SIR) was calculated for the risk of SM, CVD and infections. For SM and CVD the risk also was stratified and calculated for family history of disease. The Swedish Hodgkin Intervention and Prevention study (SHIP), a prospective study, invited 702 individuals treated for HL at the age of 45 years or younger and who were treated in the region of Skåne, Uppsala or Umeå. The participants completed a questionnaire and were invited to an out-patient visit to an oncologist with clinical examination and blood tests. Any pathological findings were referred for further investigation.

Results An increased risk for SM in HL long-term survivors was observed and seems to increase with the number of FDRs with cancer. There was also an increased risk for inpatient care due to congestive heart failure (CHF) and coronary artery disease (CAD). A family history of CHF and CAD further increased the risk for these diseases. The risk for inpatient care due to infections was increased and remained increased after 20 years or longer. The risk for infections was associated with splenectomy and hypothyroidism. Radiotherapy was an independent risk factor for cardiovascular disease in the cohort of the prospective study.

ConclusionLong-term survivors from HL have an increased risk for developing late side effects such as SM, CVD and infections. Since many HL patients are young and the cure rate from the disease is high, it is of great importance to offer focused surveillance programs to selected individuals who are at high risk, e.g. individuals who received radiotherapy as part of their treatment and who have other known risk factors for cardiovascular disease such as hypertension, hypercholesterolemia, family history and smoking.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2011. 46 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1416
Keyword
Hodgkin, survivorship, long-term side effects, cardiovascular disease, second malignancy, infections, prevention
National Category
Cancer and Oncology
Research subject
Oncology
Identifiers
urn:nbn:se:umu:diva-43287 (URN)978-91-7459-188-0 (ISBN)
Public defence
2011-05-20, Bergasalen, By 27, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
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Available from: 2011-04-29 Created: 2011-04-26 Last updated: 2011-04-29Bibliographically approved

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CiteExportLink to record
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