Late effects. Treatment for malignant lymphoma with a curative intent carries a risk for early as well as late side effects. The late effects in Hodgkins disease have been investigated in two doctoral thesis (May Brit Lund, Arne Foss Abrahamsen, 1999). Some conclusions from the studies are:
- One of three patients who have received radiotherapy to a mantle field have detectable cardiac sequelae after a median of ten years. In most cases, an aortic or a mitral valve regurgitation of uncertan clinical significance was found. Pericarditits and an increased risk of coronary artery occlusion were also seen.
- Radiotherapy to a mantle field induces decreased lung function capacity, but for most patients this sequala does not interfere with the ordinary quality of life. Some patients compålain of dyspnoea on exertion.
- Radiotherapy to a mantle field induces a biochemical hypothyreosis in the majority of patients with longer follow up. Other sequelae are muscle pain and fibrosis and increased expences to dental care. Patients who have received gonadotoxic treatment have infertility problems as expected.
- With prolonged follow up after curative treatment for Hodgkins disease, the rate of patients on disability pension is twice that of the general population
- Patients with a splenectomy carry an increased risk of serious pneumococcal infections later in life and should receive vaccination against pneumococcae before and after splenectomy.
- Furthermore, long term follow up of Hodgkins disease survivors has shown that females irradiated to a mantle field before the age of 25-30 years carry an increased risk of breast cancer (j Foss Abrahamsen et al. J Clin Oncol. ...) These findings are in accordance with studies from other centers and have resulted in the following advice, in accordance with international recommendation:
- Women irradiated to a mantle field or a similar volume before the age of 30 years should be offered yearly mammography after ten years in line with patients with a familary disposition for breast cancer.
Quality of life. With an increasing number of patients being cured for malignant lymphoma, the quality of life of the patients has become an important issue. This has been investigated in two doctoral thesis, one in patients with malignant lymphoma or leukemia undergoing autologous (ASCT) or allogeneic bone marrow transplantation (SCT) (Marianne Jensen Hjermstad, 1999), and one with emphasis on chronic fatigue in patients being cured for Hodgkins disease (Jon Håvard Loge, 1999). The major conlusions were:
- The large majority of patients recover reasonably well within one year after ASCT or SCT with two of three patients back to work or studies. However, impaired role, social functioning and financial difficulties prevail. Patients at risk for anxiety and depression could be identified.
- In Hodgkins disease survivors, there is an increased frequency of anxiety, depression and fatigue, the latter seen in 26% of the patients compared to 11% in the general Norwegian population.