Long-term Survivors Of Hodgkin's Disease Research Articles

Second Primary Malignancies and Cardiovascular Mortality in Hodgkin disease Survivors — a Surveillance, Epidemiology, and End Results Registry Database Study

BackgroundOver the last few decades there has been significant improvements in survival in patients with Hodgkin disease (HD). But long-term HD survivors, especially those treated with radiation therapy (RT) have an increased risk of second primary malignancy and cardiovascular disease (CVD) related mortality. In this context, we conducted this population based study to analyze trends in CVD related mortality and incidence of lung and thyroid cancer in HD survivors treated with RT.Materials and methodsWe used the Surveillance, Epidemiology, and End Results 9 database to calculate the Standardized Incidence Ratio (SIR) and Excess Absolute Risk (EAR) of lung and thyroid cancer as second primary malignancies in survivors of HD diagnosed between 1973 and 2011, and who were treated with RT. Poisson regression models were used to calculate adjusted incidence of lung and thyroid cancer. We further divided the patients diagnosed with HD during this period into two groups based on if or not they received RT and calculated the mortality due to CVD for each group, by year of diagnosis. Poisson regression models were used to calculate adjusted CVD mortality by year of HD diagnosis for each group. In all three cases, trends in incidence or mortality were evaluated by calculating the Estimated Annual Percentage Change (EAPC) from the regression coefficient for year of diagnosis.ResultsWe identified 11,916 HD cases that received RT from the SEER database, who were followed up for a median duration of 160 months (range - 12 to 480 months). Table 1 provides characteristics of the study population. 319 patients developed lung cancer (SIR of 3.72, 95% CI 3.32 - 4.15; EAR of 13.19 per 10,000 person years at risk) and 86 patients developed thyroid cancer (SIR of 3.67, 95% CI 2.94 - 4.53; EAR of 3.54 per 10,000 person years at risk). Median ages at diagnosis of secondary lung and thyroid cancers were 59 years and 42 years respectively, with median latency periods of 16 years and 17 years respectively. 965 patients among 11,916 patients who received RT died from CVD while the number of CVD deaths was 1,182 among the 12,507 patients who were not administered RT.Using Poisson regression models, we calculated the adjusted incidence of secondary lung cancer and thyroid cancer and the adjusted mortality from CVD, by year of diagnosis. Year of diagnosis, age at diagnosis of HD and latency (time since diagnosis of HD) were the independent variables used in the regression model. Between 1973 and 2011, the adjusted incidence of lung cancer declined at an EAPC of -2.68 (95% CI -13.06 to -3.92) and that of thyroid cancer declined at an EAPC of -3.35 (95% CI -5.73 to -1.00) (Figure 1). Over the same period, CVD mortality per 10,000 person years at risk for patients who received RT declined at an EAPC of -4.34 (95% CI -4.97 to -3.73) and that of patients who did not receive RT declined at an EAPC of -1.92 (95% CI -2.47 to -1.39) (Figure 2).ConclusionWe observed a decline in incidence of lung and thyroid malignancies and CVD mortality in HD survivors over the study period. The decline in CVD mortality over time in patients who received RT was steeper compared to that of patients who did not receive RT. Though our study was limited by the lack of details regarding RT, chemotherapy and comorbidities, these findings are most likely a reflection of recent trends in use of reduced doses and field of RT. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Second Primary Malignancies and Cardiovascular Mortality in Hodgkin Disease (HD) Survivors – A SEER Database Study

Over the last few decades there has been significant improvements in survival in patients (pts) with HD. But long-term HD survivors, especially those treated with radiation therapy (RT) have an increased risk of second primary malignancy (SPM) and cardiovascular disease (CVD) related mortality. We conducted this population based study to analyze trends in CVD related mortality and incidence of lung and thyroid cancer (CA) in HD survivors treated with RT. We used the SEER 9 database to calculate the Standardized Incidence Ratio (SIR) and Excess Absolute Risk (EAR) of lung and thyroid CA as SPM in survivors of HD diagnosed between 1973 and 2011, who were treated with RT. Poisson regression models were used to calculate adjusted incidence of lung and thyroid CA. We also divided the pts diagnosed with HD during this period into two groups based on if or not they received RT and calculated the mortality due to CVD for each group, by year of diagnosis (YOD). Poisson regression models were used to calculate adjusted CVD mortality by YOD for each group. In all three cases, trends in incidence or mortality were evaluated by calculating the Estimated Annual Percentage Change (EAPC) from the regression coefficient for YOD. We identified 11,916 HD cases that received RT, who were followed up for a median duration of 160 months (range – 12 to 480 months). 319 pts developed lung CA (SIR of 3.72, 95% CI 3.32 – 4.15; EAR of 13.19 per 10,000 person years at risk (PYAR)) and 86 pts developed thyroid CA (SIR of 3.67, 95% CI 2.94 – 4.53; EAR of 3.54 per 10,000 PYAR). Median ages at diagnosis of secondary lung and thyroid CA were 59 yrs and 42 yrs, with median latency periods of 16 yrs and 17 yrs respectively. 965 pts among 11,916 pts who received RT died from CVD while the number of CVD deaths was 1,182 among the 12,507 pts who were not given RT. Using Poisson regression models, we calculated the adjusted incidence of secondary lung CA and thyroid CA and the adjusted mortality from CVD, by YOD. YOD, age at diagnosis of HD and latency (time since diagnosis of HD) were the independent variables used in the regression model. Between 1973 and 2011, the adjusted incidence of lung CA declined at an EAPC of -2.68 (95% CI -13.06 to -3.92) and that of thyroid CA declined at an EAPC of -3.35 (95% CI -5.73 to -1.00). Over the same period, CVD mortality per 10,000 PYAR for pts who received RT declined at an EAPC of -4.34 (95% CI -4.97 to -3.73) and that of pts who did not receive RT declined at an EAPC of -1.92 (95% CI -2.47 to -1.39). We observed a decline in incidence of lung and thyroid CA and CVD mortality in HD survivors over the study period. The decline in CVD mortality over time in pts who received RT was steeper compared to that of pts who did not receive RT. Though our study was limited by the lack of details regarding RT, chemotherapy and comorbidities, these findings are most likely a reflection of recent trends in use of reduced doses and field of RT.

3-D reconstruction of anterior mantle-field techniques in Hodgkin's disease survivors: doses to cardiac structures

BackgroundThe long-term dose-effect relationship for specific cardiac structures in mediastinal radiotherapy has rarely been investigated. As part of an interdisciplinary project, the 3-D dose distribution within the heart was reconstructed in all long-term Hodgkin's disease survivors (n = 55) treated with mediastinal radiotherapy between 1978 and 1985. For dose reconstruction, original techniques were transferred to the CT data sets of appropriate test patients, in whom left (LV) and right ventricle (RV), left (LA) and right atrium (RA) as well as right (RCA), left anterior descending (LAD) and left circumflex (LCX) coronary arteries were contoured. Dose-volume histograms (DVHs) were generated for these heart structures and results compared between techniques.ResultsPredominant technique was an anterior mantle field (cobalt-60). 26 patients (47%) were treated with anterior mantle field alone (MF), 18 (33%) with anterior mantle field and monoaxial, bisegmental rotation boost (MF+ROT), 7 (13%) with anterior mantle field and dorsal boost (MF+DORS) and 4 (7%) with other techniques. Mean ± SD total mediastinal doses for MF+ROT (41.7 ± 3.5 Gy) and for MF+DORS (42.7 ± 7.4) were significantly higher than for MF (36.7 ± 5.2 Gy). DVH analysis documented relative overdosage to right heart structures with MF (median maximal dose to RV 129%, to RCA 127%) which was siginificantly reduced to 117% and 112%, respectively, in MF+ROT. Absolute doses in right heart structures, however, did not differ between techniques. Absolute LA doses were significantly higher in MF+ROT patients than in MF patients where large parts of LA were blocked. Median maximal doses for all techniques ranged between 48 and 52 Gy (RV), 44 and 46 Gy (LV), 47 and 49 Gy (RA), 38 and 45 Gy (LA), 46 and 50 Gy (RCA), 39 and 44 Gy (LAD) and 34 and 42 Gy (LCX).ConclusionIn patients irradiated with anterior mantle-field techniques, high doses to anterior heart portions were partly compensated by boost treatment from non-anterior angles. As the threshold doses for coronary artery disease, cardiomyopathy, pericarditis and valvular changes are assumed to be 30 to 40 Gy, cardiac toxicity must be anticipated in these patients. Thus, dose distributions in individual subjects should be correlated to the corresponding cardiovascular findings in these long-term survivors, e. g. by cardiovascular magnetic resonance imaging.

Quality of life in long-term Hodgkin’s disease survivors with chronic fatigue

The prevalence of chronic fatigue (CF), elevated fatigue levels >six months, is 2.5-3 times higher in long-term Hodgkin disease survivors (HDSs) than in the general population (GP). This is the first study comparing the quality of life (QoL) of chronic fatigued survivors with that of chronic fatigued subjects in the GP. The fatigue questionnaire (FQ) and the SF-36 were mailed to 591 HDSs successfully treated at the Norwegian Radium Hospital from 1971 to 1997. Patient data were compared with nationally representative GP data, adjusted for age, gender and education. The response rate was 80% (N = 475), median follow-up 195 months (range 53-431), mean age 46 years (range 21-74), and 44% were females. HDSs reported significantly poorer QoL than the GP with lower scores on six of eight SF-36 scales (P < 0.001). The subgroup of HDSs with chronic fatigue however (N = 142/475, 30%) had better QoL on five of eight SF-36 scales than subjects with CF in the GP (N = 224/2141, 11%), particularly mental health and emotional role-functioning (P = 0.005 and <0.0001). No differences were found on the physical SF-36 domains. Overall, HDSs reported lower QoL than the GP, in particular the HDSs with CF. Their QoL was similar to that of GP subjects with CF, but with significantly better mental health status. This suggests that CF in long-term survivors may be associated with more physical than psychological aspects of long-term cancer survivorship.

Fatigue in Long-Term Hodgkin's Disease Survivors: A Follow-Up Study

To describe total fatigue (TF) and chronic fatigue (CF) in 476 long-term Hodgkin's disease survivors (HDSs). The development in CF over time was explored in 280 of the patients who had also been assessed 8 years earlier. In 2003, the Fatigue Questionnaire was mailed to 610 successfully treated HDSs at the Norwegian Radium Hospital from 1971 to 1997. Mean TF scores and occurrence of CF were compared with general population (GP) values. Four hundred seventy-six complete forms (81%) were received (median age, 46 years; 56% males, median follow-up time, 195 months). There was a positive association between age and TF (P < .05), whereas presence of B symptoms at diagnosis and treatment before 1980 were associated with CF. Mean TF scores were elevated in HDSs compared with the GP (mean TF score, 14.6; 95% CI, 14.1 to 15.7 v 12.1; 95% CI, 11.9 to 12.3, respectively; P < .001), as was the proportion of persons with CF (30% v 11%, respectively; odds ratio = 3.6; P < .001). The 70 patients with CF 8 years earlier still reported higher TF at follow-up than the 210 patients without CF at the previous assessment (mean TF score, 17.0; 95% CI, 15.6 to 18.3 v 13.1; 95% CI, 12.9 to 14.1, respectively; P < .001). Significantly more patients with persisting CF had B symptoms at diagnosis compared with patients who had recovered (P = .05). No significant association with treatment modality and intensity was found. Fatigue remains a major complaint in HDSs several years after treatment, but the association between treatment and fatigue still remains unclear. Many HDSs may recover from CF, particularly patients without B symptoms at diagnosis.

Evaluation of left ventricular function in long‐term survivors of childhood Hodgkin disease

Data on the presence of myocardial abnormalities in long-term Hodgkin disease survivors are contradictory. The purpose of this study was to determine if myocardial performance index (MPI) was capable of discovering cardiac abnormalities. Echocardiographic evaluation was performed in 31 survivors of Hodgkin disease (mean age 17.0 years), who received doxorubicin as part of chemotherapeutic treatment (median dose 164.8 +/- 42.5 mg/m(2)). Control group comprised 22 healthy subjects (mean age 16.7 years). Peak A velocity was increased (P = 0.004) and peak E/A velocity ratio was lower (P = 0.002) in patients compared to controls. Mean isovolumetric contraction time was longer in patients than in controls (P = 0.0001). Ejection time was significantly shorter in patients than in the controls (P = 0.001). Consequently, the MPI was significantly greater in the patients than in the controls (P = 0.0001). Abnormal MPI was found in 25/31 patients (83%). The Doppler-derived index of combined systolic and diastolic myocardial performance demonstrates the presence of subtle cardiac abnormalities in the majority of Hodgkin disease survivors.

Cardiovascular status in long-term survivors of Hodgkin's disease treated with chest radiotherapy.

Cardiovascular status was assessed in 48 Hodgkin's disease (HD) survivors at a median of 14.3 years (range, 5.9 to 27.5 years) after diagnosis because they may be at increased risk for cardiovascular abnormalities. Patients completed the Short-Form 36 quality-of-life instrument and were screened by echocardiography, exercise stress testing, and resting and 24-hour ECG. All patients received mediastinal irradiation (median, 40.0 Gy; range, 27.0 to 51.7 Gy) at a median age of 16.5 years (range, 6.4 to 25.0 years). Four patients received an anthracycline. Although every patient described their health as good or better, and none had symptomatic heart disease at screening, all but one had cardiac abnormalities on screening. Restrictive cardiomyopathy was suggested by reduced average left ventricular (LV) dimension (P < .001) and mass (P < .001), without increased LV wall thickness. Significant valvular defects were present in 42%; 75% had conduction defects. One survivor developed complete heart block shortly after the study visit. Autonomic dysfunction was suggested by a monotonous heart rate in 57%, persistent tachycardia in 31%, and blunted hemodynamic responses to exercise in 27%. Peak oxygen uptake (VO2max) during exercise, a predictor of mortality in heart failure, was significantly reduced (< 20 mL/kg/m2) in 30% of survivors. VO2max was correlated with increasing fatigue, increasing shortness of breath (both, r = -0.35; P =. 02), and decreasing physical component score on the SF-36 (r = 0.554; P = .00017). A variety of unsuspected, clinically significant cardiovascular abnormalities are common in long-term survivors of HD who are treated at a young age with mediastinal irradiation. We recommend serial, comprehensive cardiac screening of HD survivors who fit this profile.

Stroke following therapy for Hodgkin's Disease (HD): A report from the Childhood Cancer Survivor Study (CCSS)

8523 Background: An increased risk for strokes has not been previously reported among HD survivors. This report examines the rate and risk factors for stroke in long-term survivors of HD. Methods: The CCSS is a multi-institutional cohort study of long-term (≥ 5 years) survivors who were diagnosed between 1970–1986. The rate of first occurrence of self-reported strokes was determined for HD survivors (N=1665) and compared with a random sample of siblings of childhood cancer survivors (N=3846). The mean age at interview of the HD survivors was 31.9 years of age, with a mean age at diagnosis of 14.6 years. The incidence rates of HD survivors at ≥ 5 years post diagnosis and siblings were calculated separately. Cox proportional hazards models were used to estimate rate ratio (RR) of developing stroke between HD survivals and siblings. Results: Fifteen HD survivors reported a stroke: one during therapy, 13 occurring ≥ 5 years after HD diagnosis, and one without an age at stroke reported. The rate of stroke in HD survivors ≥ 5 years post diagnosis was 0.68 per 1000 person-years (95% CI, 0.40–1.18). Of the 13 late occurring strokes, all had chest/mantle radiation (median dose 40 Gy), with a median interval of 15 years from HD diagnosis to stroke. The median age of stroke was 31 years (range 21–40). Seven siblings reported a previous stroke, with a rate of 0.069 per 1000 person-years (95% CI, 0.03–0.15). The RR of stroke for all HD survivors, in comparison with siblings, was 3.88 (95% CI, 1.46–10.3; p = 0.0065). The rate of stroke for HD survivors who were treated with chest radiation therapy (RT) was 0.82 per 1000 person-years (95% CI, 0.48–1.41). Compared to siblings, the RR of HD survivors treated with chest RT was 4.28 (95% CI, 1.6–11.2; p=0.0031). Anthracycline exposure, treatment with chemotherapy only, hypertension and diabetes mellitus were not associated with an increased risk of stroke. Conclusions: Though an infrequent outcome, survivors of childhood HD may be at an increased risk of stroke. In this study, previous exposure to chest RT was strongly associated with risk of stroke. Because the risk may be modified by prevention, it is imperative to further study this process. No significant financial relationships to disclose.

Stroke following therapy for Hodgkin's Disease (HD): A report from the Childhood Cancer Survivor Study (CCSS)

8523 Background: An increased risk for strokes has not been previously reported among HD survivors. This report examines the rate and risk factors for stroke in long-term survivors of HD. Methods: The CCSS is a multi-institutional cohort study of long-term (≥ 5 years) survivors who were diagnosed between 1970–1986. The rate of first occurrence of self-reported strokes was determined for HD survivors (N=1665) and compared with a random sample of siblings of childhood cancer survivors (N=3846). The mean age at interview of the HD survivors was 31.9 years of age, with a mean age at diagnosis of 14.6 years. The incidence rates of HD survivors at ≥ 5 years post diagnosis and siblings were calculated separately. Cox proportional hazards models were used to estimate rate ratio (RR) of developing stroke between HD survivals and siblings. Results: Fifteen HD survivors reported a stroke: one during therapy, 13 occurring ≥ 5 years after HD diagnosis, and one without an age at stroke reported. The rate of stroke in HD survivors ≥ 5 years post diagnosis was 0.68 per 1000 person-years (95% CI, 0.40–1.18). Of the 13 late occurring strokes, all had chest/mantle radiation (median dose 40 Gy), with a median interval of 15 years from HD diagnosis to stroke. The median age of stroke was 31 years (range 21–40). Seven siblings reported a previous stroke, with a rate of 0.069 per 1000 person-years (95% CI, 0.03–0.15). The RR of stroke for all HD survivors, in comparison with siblings, was 3.88 (95% CI, 1.46–10.3; p = 0.0065). The rate of stroke for HD survivors who were treated with chest radiation therapy (RT) was 0.82 per 1000 person-years (95% CI, 0.48–1.41). Compared to siblings, the RR of HD survivors treated with chest RT was 4.28 (95% CI, 1.6–11.2; p=0.0031). Anthracycline exposure, treatment with chemotherapy only, hypertension and diabetes mellitus were not associated with an increased risk of stroke. Conclusions: Though an infrequent outcome, survivors of childhood HD may be at an increased risk of stroke. In this study, previous exposure to chest RT was strongly associated with risk of stroke. Because the risk may be modified by prevention, it is imperative to further study this process. No significant financial relationships to disclose.

Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease.

Second cancer is the leading cause of death in long-term survivors of Hodgkin disease (HD), with exceptionally high risks of breast cancer among women treated at a young age. Quantitative associations between radiotherapy dose delivered to the breast and administered chemotherapy have not been reported to date in large series, nor has the influence of ovarian exposures on subsequent risk. To quantify the long-term risk of breast cancer associated with use of radiotherapy and chemotherapy to treat young women with HD. Matched case-control study of breast cancer within a cohort of 3817 female 1-year survivors of HD diagnosed at age 30 years or younger, between January 1, 1965, and December 31, 1994, and within 6 population-based cancer registries. The study was conducted March 1, 1996, through September 30, 1998. Relative risk (RR) of breast cancer associated with radiation dose delivered to site of breast cancer or to ovaries and with cumulative dose of alkylating agents. Breast cancer occurred in 105 patients with HD who were matched to 266 patients with HD but without breast cancer. A radiation dose of 4 Gy or more delivered to the breast was associated with a 3.2-fold (95% confidence interval [CI], 1.4-8.2) increased risk, compared with the risk in patients who received lower doses and no alkylating agents. Risk increased to 8-fold (95% CI, 2.6-26.4) with a dose of more than 40 Gy (P<.001 for trend). Radiation risk did not vary appreciably by age at exposure or reproductive history. Increased risks persisted for 25 or more years following radiotherapy (RR, 2.3; 95% CI, 0.5-16.5; P =.03 for trend with dose). Treatment with alkylating agents alone resulted in a reduced risk (RR, 0.6; 95% CI, 0.2-2.0) of breast cancer, and combined alkylating agents and radiotherapy in a 1.4-fold (95% CI, 0.6-3.5) increased risk. Risk of breast cancer decreased with increasing number of alkylating agent cycles (P =.003 for trend). Risk also was low (RR, 0.4; 95% CI, 0.1-1.1) among women who received 5 Gy or more delivered to ovaries compared with those who received lower doses. Hormonal stimulation appears important for the development of radiation-induced breast cancer, as evidenced by the reduced risk associated with ovarian damage from alkylating agents or radiation. The high radiation-related risk, which did not diminish at the highest doses or the longest follow-up, however, suggests the need for lifetime surveillance and programs of patient and public awareness.

Current therapies in Hodgkin's disease.

Advances in the treatment of Hodgkin's disease (HD) have resulted in cure rates of greater than 80%. This remarkable achievement has occurred in the past 50 years secondary to improvements in combination chemotherapy and radiotherapy. Over the last several decades, with the increase in long-term survivors of HD, it has become evident that cure is not the only issue, and late side-effects of treatment, including secondary malignancies and impaired fertility, are of major concern as well. As a result, attempts to improve response and survival rates by intensifying therapy must be countered against the potential for long-term toxicity.

Quality of life and psychological well-being in Spanish long-term survivors of Hodgkin's disease: results of a controlled pilot study.

Nowadays, the chemoradiotherapeutic protocols for Hodgkin's disease (HD) achieve high curability rates. Hemato-oncologists focus on both avoiding medical and psychological sequelae of the treatment and returning patients to a normal life. The quality of life and psychological well-being of Spanish patients who are long-term survivors of HD were studied and compared to the results obtained from healthy controls. Questionnaires on quality of life [European Organization for Research and Treatment of Cancer (EORTC) QLQ30] and psychological status [hospital anxiety and depression (HAD) scale] were mailed to HD patients without active disease and free of second malignancies and were also given to healthy controls. Of 67 selected patients (68.6%), 46 were included in this study. The median follow-up for these 46 patients was of 7.6 years (0.8-22.1) after being diagnosed. Although there were no differences between patients and controls with regard to their global state of health and quality of life (72.9+/-22.7 vs 79.3+/-18.7; p=0.22), patients presented a lower physical function (88.2+/-18.1 vs 96.5+/-9.7; p=0.05) and a worse social operation scale (81.5+/-25.4 vs 96.3+/-13.1; p= 0.0015) together with higher symptoms of dyspnea (8.6+/-14.7 vs 0+/-0; p=0.03) and higher economic difficulties (23.1+/-38.3 vs 0.7+/-4.9; p=0.017) when compared with healthy controls. However, we did not find differences in the scores and the proportion of cases of anxiety and depression between the two groups. The quality of life questionnaire disclosed differences between patients and controls in some functional and symptomatic scales. These differences can be read as a consequence of either the disease itself or the treatment received. However, the results of this controlled pilot study should be confirmed in a larger series of Spanish HD survivors. In the future, these results could be a reference when new therapeutic protocols are designed to reduce the impact on the quality of life of the patients. Socioeconomic support to the patients should also be provided in order to improve their medical care.

Pneumococcal Vaccine in Patients With Absent or Dysfunctional Spleen

Four patients (3 long-term Hodgkin disease survivors and 1 recipient of an allogeneic bone marrow transplant) developed severe infections with Streptococcus pneumoniae after staging splenectomy or due to functional hyposplenism after total body irradiation and bone marrow transplantation. Current guidelines for prevention of infection recommend pneumococcal immunization for patients with Hodgkin disease treated with splenectomy and others with functional hyposplenism. Booster vaccination after 5 years is also advised. Hospital- and community-based vaccination initiatives may help identify at-risk patients.

Reduced health-related quality of life among Hodgkin's disease survivors: A comparative study with general population norms

Late complications after curative treatment of Hodgkin's disease are of special relevance because most of the cured are young adults. The aims of the present study were: (1) to compare health-related quality of life (HRQOL) in Hodgkin's disease (HD) survivors with normative data from the general Norwegian population and (2) to examine the relations between disease/treatment characteristics and HRQOL in the HD survivors. 459 HD survivors aged 19-74 years (mean 44.0, SD 11.8) treated at the Norwegian Radium Hospital 1971-1991 were approached in 1994 and compared to norms from 2214 subjects approached in 1996. The norms are representative of the general Norwegian population. HRQOL was assessed by the Short Form 36 (SF-36), which measures HRQOL in eight separate scales (0 = worst health state, 100 = best health state). The HD survivors had lower scores than the normal controls on all scales after adjustment for age, gender and educational levels. Statistically significant differences (P < 0.01) were found in general health (10.4), physical functioning (6.1), role limitations (physical, 9.3), physical functioning (3.6) and in vitality (4.7). Patients with disease stage IB-IIB had the lowest scores on all scales. The differences in relation to stage/substage reached statistical significance (P < 0.01) in physical functioning and in role limitations (physical). Time since diagnosis, types of primary treatment or having relapsed were not associated with statistically significant differences in HRQOL. Long-term HD survivors have poorer HRQOL, primarily in physical health, than the general Norwegian population.

Late psychosocial sequelae in Hodgkin's disease survivors: a French population-based case-control study.

To evaluate late psychosocial sequelae in long-term survivors of Hodgkin's disease (HD) in the population of Calvados, France. Ninety-three patients issued from the Calvados General Tumor Registry, treated from 1978 to 1990, free of relapse and second malignancy since January 1991, were enrolled onto cross-sectional case-control study. One hundred eighty-six healthy controls, matched for sex, age, and residency, were selected at random from electoral rolls. Two self-administered questionnaires were mailed in the spring of 1995. Compared with controls, HD patients reported (1) more physical (P < .001), role (P < .001), and cognitive (P = .015) functioning impairments, as well as dyspnea (P < .001) and chronic fatigue (P = .025), while no statistical difference was found in global health status; (2) to be more often childless (P = .04), fewer divorces or separations (P = .013), fewer changes in relationships with friends (P = .012), similar proportions at work but less ambitious professional plans (P < .001), and greater difficulties in borrowing from banks (P < .001); (3) a slight increase in the number of visits to a general practitioner (P = .05) and greater consumption of medical resources (mainly thyroid extracts, P = .05). The study demonstrated that French long-term HD survivors have good global health status and good psychologic, familial, and professional status, although difficulties in borrowing from banks remain a major limitation in daily life. Although physical, role, and cognitive functioning impairments persist that might limit their activities, HD survivors seem to have learned to cope with problems related to their disease and its treatment.

Sonographic abnormalities of the thyroid gland in longterm survivors of Hodgkin disease

We studied the thyroid gland in 18 long term survivors of Hodgkin Disease, all of whom received radiation therapy (2400-4000 cGy, mean 3434). Evaluation included clinical examination, thyroid function tests, ultrasound, as well as selective use of nuclear scintigraphy. The time interval post radiation was 1-16 years (mean 6.4 years). Clinical evaluation and thyroid function tests were insensitive in detecting abnormalities and most nodules were non palpable. Ultrasound detected abnormalities in 16 patients (89%) including diffuse atrophy (n = 6), solitary nodules (n = 4), multiple nodules (n = 5) and gland heterogeneity with calcification in one patient. Cold nodules on nuclear scintigraphy (n = 4) were subjected to biopsy. Multiple foci of papillary carcinoma were found in one patient. There was a tendency for nodules to increase in number as the post radiation interval also increased. We recommend frequent sonographic evaluation and early suppression of thyroid stimulation in an attempt to arrest the development of neoplastic changes.