title: Late morbidity and mortality in patients with Hodgkin's lymphoma treated during adulthood.
abstract: BACKGROUND
  Survivors of Hodgkin's lymphoma (HL) treated as adults are at risk for late effects of therapy. However, the burden of late morbidity and mortality among adults treated for HL remains incompletely characterized.
  
  
  METHODS
  Vital status and, for deceased, cause of death were determined for 746 adults treated on a first-line trial at a single center from 1975 to 2000. Survivors completed a detailed survey describing their physical and mental health. A severity score (grades 1-4, ranging from mild to life-threatening or disabling) was assigned to self-reported conditions.
  
  
  RESULTS
  At a median follow-up of 22 years, 227 of patients (30.4%) had died, 107 (47.1%) from HL, 120 (52.9%) from other causes, including second primary malignancies (SPMs) (n = 52) and cardiovascular disease (n = 27). Across the duration of follow-up, all-cause and SPM-specific risk of death remained higher than predicted by normative data. Among survivors, late morbidity survey data are available for 238 patients (45.9%). Ninety-four-point-one percent of respondents reported at least one morbidity, and 47.5% reported at least one grade 3 or 4 morbidity; 20.2% reported two or more grade 3 morbidities. Commonly reported morbidities included cardiovascular (54.6%), endocrine (68.5%), pulmonary disease (21.4%), and nonfatal second malignancy (23.1%). Anxiety, depression, and fear of recurrence were frequently reported.
  
  
  CONCLUSIONS
  Among a large cohort of patients treated for HL with extensive follow-up, risk of late mortality from causes other than HL and prevalence of late medical morbidity are high. Guidelines for prevention, screening, and management of late effects in adult survivors of HL are needed.
authors.affiliation: Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, DJS); Department of Medicine, Weill Cornell Medical College, New York, NY (MJM, DJS); Adult Survivorship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, KCO); Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY (JSF); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (ERR, TS); Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY (JSF, KCO). matasarm@mskcc.org.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Matasar
authors.affiliation: Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, DJS); Department of Medicine, Weill Cornell Medical College, New York, NY (MJM, DJS); Adult Survivorship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, KCO); Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY (JSF); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (ERR, TS); Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY (JSF, KCO).
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Ford
authors.affiliation: Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, DJS); Department of Medicine, Weill Cornell Medical College, New York, NY (MJM, DJS); Adult Survivorship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, KCO); Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY (JSF); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (ERR, TS); Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY (JSF, KCO).
authors.forename: Elyn R
authors.initials: ER
authors.lastname: Riedel
authors.affiliation: Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, DJS); Department of Medicine, Weill Cornell Medical College, New York, NY (MJM, DJS); Adult Survivorship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, KCO); Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY (JSF); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (ERR, TS); Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY (JSF, KCO).
authors.forename: Talya
authors.initials: T
authors.lastname: Salz
authors.affiliation: Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, DJS); Department of Medicine, Weill Cornell Medical College, New York, NY (MJM, DJS); Adult Survivorship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, KCO); Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY (JSF); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (ERR, TS); Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY (JSF, KCO).
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Oeffinger
authors.affiliation: Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, DJS); Department of Medicine, Weill Cornell Medical College, New York, NY (MJM, DJS); Adult Survivorship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, KCO); Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY (JSF); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (ERR, TS); Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY (JSF, KCO).
authors.forename: David J
authors.initials: DJ
authors.lastname: Straus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D002423:Cause of Death; D004700:Endocrine System Diseases / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008171:Lung Diseases / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009017:Morbidity; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000401:mortality; D016017:Odds Ratio; D015995:Prevalence; D012306:Risk; D011795:Surveys and Questionnaires; D013997:Time Factors