Late Effects: An Evaluation of Contrasting Physical and Psychological Experiences Between Child and Adult Hodgkin Survivors

Purpose

A retrospective study to assess the effect of age at diagnosis (AD) of patients with Hodgkin’s Lymphoma (HL) on the development of physical late effects (secondary malignancies, hyperthyroidism, fatigue), depressive symptoms and quality of life (QOL) using the Impact of Cancer (positive and negative scales) Questionnaire.

Methods

280 Hodgkin’s Lymphoma (HL) survivors from St. Bartholomew’s Hospital, London were divided into two groups; 57 Childhood (AD≤17 years) Hodgkin’s Lymphoma (CHL) and 223 Adult (AD≥18 years) Hodgkin’s Lymphoma (AHL). Chi-square/Fisher’s exact tests and logistic regression analyses were conducted to identify the effect of AD on late effects; adjusting for histological subtype (HS) and treatment modality (TM). For IOC, two separate hierarchical linear regression analyses were conducted to examine the combined association of; (i) AD, HS and TM (ii) AD, HS, TM and the late effects on IOC.

Results

CHL survivors were four times more likely to develop a secondary malignancy than AHL survivors (P=0.011). AD was not associated with hyperthyroidism, fatigue or depression. Higher negative IOC scores were significantly associated with lower levels of social support and two or more medical co-morbidities (P≤0.001). Although there was no significant association between AD and negative IOC, lower positive IOC scores were significantly associated with CHL (P=0.040).

Conclusions

CHL survivors may benefit from more vigorous screening for secondary malignancies to enable their early detection and treatment. QOL varies in different groups and those with less social support and more medical co-morbidities would benefit from interventions to reduce negative IOC. An early psychological intervention to increase positive IOC and resilience for young people with HL may also improve their future QOL as long-term CHL survivors.