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Evaluation of the Risk of Therapy-Associated Complications in Survivors of Hodgkin Lymphoma

Correspondence: Lois B. Travis, MD, ScD, Exponent, Inc., 420 Lexington Avenue, Suite 1740, New York NY 10170; phone: (212) 895-8108; fax: (212) 895-8199; ltravis{at}exponent.com

Abstract

Given the improvements in survival of patients with Hodgkin lymphoma (HL) in the last three decades, quantification of the late effects of successful treatment has become critical. Since the highest incidence rates of HL occur at ages 20 to 34 years, large numbers of patients remain at lifelong risk for the late effects of treatment. Deaths due to second cancers are now the most common cause of mortality among long-term survivors of HL, followed by cardiac disease. Risk measures of these and other late sequelae, however, can vary markedly between investigations, depending on the types of treatment, the rigor with which epidemiologic study designs are applied, ascertainment of events of interest, the duration and completeness of follow-up, and consideration of competing risks. Further, numerous influences apart from therapy can affect late effects, including patient age, sex, race, lifestyle factors (tobacco, alcohol, diet), comorbidities, and the underlying cancer process. In the future, it will become increasingly important for health-care providers to be able to critically evaluate the risk of late effects in HL survivors, which will include a working knowledge of various epidemiologic study designs and risk measures and an ability to judiciously review the medical literature. In this article, the methods, significance and caveats in calculating and reporting risks of complications of treatment for HL are reviewed.

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