title: Late mortality, secondary malignancy and hospitalisation in teenage and young adult survivors of Hodgkin lymphoma: report of the Childhood/Adolescent/Young Adult Cancer Survivors Research Program and the BC Cancer Agency Centre for Lymphoid Cancer.
abstract: Late complications affecting Hodgkin lymphoma (HL) survivors are well described in paediatric and adult-based publications. This study determined the late morbidity and mortality risk for 442 teenage and young adult (TYAs) 5-year HL survivors, diagnosed at 15-24 years of age between 1970 and 1999, identified from the British Columbia Cancer Registry. Treatment details were abstracted from charts. Survivors and a matched comparison cohort were linked to provincial administrative health datasets until December 2006 and regression analysis was performed, providing risk ratios regarding mortality, secondary malignancy and morbidity causing hospitalisation. Sixty (13·6%) survivors experienced late mortality with excess deaths from secondary cancer [standardised mortality ratio (SMR) 18·6; 95% confidence interval (CI) 11-29·4] and non-malignant disease (SMR 3·6; 95% CI 2·2-5·5). Excess secondary cancers (standardised incidence ratio 7·8; 95% CI 5·6-10·5) were associated with radiotherapy [Hazard ratio (HR) 2·7; 95% CI 1-7·7] and female gender (HR 1·8; 95% CI 1-3·4). Of 281 survivors treated between 1981 and 1999, 143 (51%) had morbidity resulting in hospitalisation (relative risk 1·45; 95% CI 1·22-1·73). Hospitalisation significantly increased with combined modality therapy, chemotherapy alone and recent treatment era. TYA HL survivors have excess risk of mortality and secondary malignancy continuing 30 years from diagnosis. Radiotherapy is associated with secondary malignancy and current response-adapted protocols attempt to minimise exposure, but late morbidity causing hospitalisation remains significant.
authors.affiliation: Paediatric, Teenage & Young Adult (TYA) Haematology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK.|Division of Hematology, Oncology and Bone Marrow Transplant, British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Kaljit S
authors.initials: KS
authors.lastname: Bhuller
authors.affiliation: Cancer Control Research Program, British Columbia Cancer Research Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Cancer Control Research Program, British Columbia Cancer Research Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
authors.forename: Dongdong
authors.initials: D
authors.lastname: Li
authors.affiliation: Division of Medical Oncology and Centre for Lymphoid Cancer, British Columbia Cancer Agency and University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Laurie H
authors.initials: LH
authors.lastname: Sehn
authors.affiliation: Division of Radiation Oncology, British Columbia Cancer Agency and University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Goddard
authors.affiliation: Cancer Control Research Program, British Columbia Cancer Research Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.|School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Mary L
authors.initials: ML
authors.lastname: McBride
authors.affiliation: Division of Hematology, Oncology and Bone Marrow Transplant, British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Rogers
mesh_terms: D000293:Adolescent; D001955:British Columbia / Q000453:epidemiology; D005260:Female; D006689:Hodgkin Disease / Q000401:mortality* / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology / Q000209:etiology; D016609:Neoplasms, Second Primary / Q000453:epidemiology / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects; D012042:Registries; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data; D055815:Young Adult
keywords: chemotherapy; hodgkin lymphoma; late effects; radiotherapy; teenage and young adult cancer