Impact of Cardiovascular Counseling and Screening in Hodgkin Lymphoma Survivors

Daniëls, Laurien A.; Krol, Augustinus D.G.; Graaf, Michiel A. de; Scholte, Arthur J.; Veer, Mars B. van ‘t; Putter, Hein; Roos, Albert de; Schalij, Martin J.; Poll‐Franse, Lonneke V. van de; Creutzberg, Carien L.

doi:10.1016/j.ijrobp.2014.05.038

Cited by 8 publications

(8 citation statements)

References 22 publications

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“…40 Prospective screening studies among HL survivors demonstrate that clinically significant cardiovascular abnormalities, like coronary artery stenosis, coronary artery calcifications, reduced left ventricular dimensions, VHD, and conduction defects, are very common, even in asymptomatic survivors. [45][46][47][48] Large cohort studies of HL survivors show a two-to sevenfold increased risk of cardiac death (mainly myocardial infarction [MI]), depending on the age of the patients (stronger risk increases for radiotherapy at younger ages), treatment regimens used, and followup time. 2,5,49,50 Furthermore, three-to sixfold increased SIRs of CHD, VHD, and HF are observed in patients treated for HL relative to the general population, also after long-term follow up.…”

Section: Risk Of Cvdmentioning

confidence: 99%

Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment

Leeuwen

2016

Hematology

104

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Long-term survivors of Hodgkin lymphoma (HL) experience several late adverse effects of treatment, with second malignant neoplasms (SMNs) and cardiovascular diseases (CVDs) being the leading causes of death in these patients. Other late effects have also been identified, such as pulmonary dysfunction, endocrinopathies (thyroid dysfunction, infertility), neck muscle atrophy, and persistent fatigue. HL survivors have two-to fourfold increased risks to develop SMNs and CVD compared with the general population. With respect to SMNs, radiotherapy is associated with 1.5-to 15-fold increased risk of solid malignancies. The relative risk (RR) of solid tumors increases steadily with increasing follow-up time from 5 to 15 years since radiotherapy, and remains elevated for at least 40 years. The RR of solid SMNs increases strongly with younger age at first treatment. Risks of lung, breast, and gastrointestinal (GI) cancers increase with higher radiation dose. Alkylating agent chemotherapy, especially procarbazine, does not only increase risk of leukemia but also of solid malignancies, in particular, cancers of the lung and GI tract. In contrast, gonadotoxic chemotherapy decreases the risk of radiation-associated breast cancer, through induction of premature menopause. Smoking appears to multiply the radiation-and chemotherapy-associated risks of lung cancer. Both radiotherapy and chemotherapy for HL may cause cardiovascular toxicity. Radiotherapy increases the risk of coronary heart disease, valvular heart disease, congestive heart failure (HF), and pericarditis, whereas anthracycline-containing chemotherapy increases the risks of HF and valvular heart disease. Cardiovascular toxicity following radiotherapy is usually observed from 5 to at least 35 years after therapy, whereas anthracycline-related toxicity is already observed during treatment, up to at least 25 years. The joint effects of anthracyclines, radiotherapy, and conventional cardiovascular risk factors (eg, hypertension, smoking, and physical inactivity) appear to be additive rather than multiplicative. HL survivors need lifelong risk-based screening for selected SMNs and CVDs. Furthermore, preventive strategies should include lifestyle and drug-based interventions to minimize exposure to conventional risk factors for cancer and CVD. Learning Objectives• Know treatment-related risk factors for the development of second malignancy and CVDs after HL • Be aware of the content of use surveillance guidelines for HL survivors, aimed at reduction of morbidity and mortality from second malignancy and CVDs

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Section: Risk Of Cvdmentioning

confidence: 99%

Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment

Leeuwen

2016

Hematology

104

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“…A recent study found significant benefits from a cardiovascular screening intervention on improved patient knowledge and satisfaction with care for survivors of HL. 41 We found that the use of nonrecommended PET scanning in the year after treatment increased over time, with a high of 58% among patients diagnosed in 2010. This is concerning, because use of nonrecommended services may contribute to health care costs and patient harms.…”

Section: Discussionmentioning

confidence: 80%

“…In addition to the potential benefit of initiating early treatment for cardiovascular disease and breast cancer, late effects screening programs for the AYA population have the potential to provide educational benefit. A recent study found significant benefits from a cardiovascular screening intervention on improved patient knowledge and satisfaction with care for survivors of HL …”

Section: Discussionmentioning

confidence: 99%

Use of recommended posttreatment services for adolescent and young adult survivors of Hodgkin lymphoma

Hahn

Munoz-Plaza

et al. 2019

Cancer

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Background Hodgkin lymphoma (HL) is a leading cancer diagnosis for adolescents and young adults (AYAs), with an overall 5‐year survival rate of >80%. However, to the authors’ knowledge, little is known regarding posttreatment patterns of care. In the current study, the authors characterized the use of guideline‐recommended services in a cohort of AYA survivors of HL in Kaiser Permanente Southern California. Methods Patients with HL who were diagnosed between ages 15 and 39 years between 2000 and 2010 were identified. The authors calculated the number of patients who received recommended short‐term care within 2 years after treatment cessation for those who remained enrolled and alive from 2001 through 2015. Use of recommended late‐effects screening for breast cancer and cardiovascular disease was examined. Logistic regression was used to evaluate the association between receipt of recommended care and patient, cancer, and treatment characteristics. Results A total of 354 patients were identified, with a mean age at the time of diagnosis of 26 years (standard deviation, 6.9 years). Approximately 12% of patients had stage I disease, 59% had stage II disease, 17% had stage III disease, and 13% of patients had stage IV disease. Nearly all patients received chemotherapy (95%), 51% received radiotherapy, and 5% received care from a pediatric oncologist. Overall, approximately 49% of patients received recommended short‐term care. Of those patients eligible for cardiovascular screening at 10 years posttreatment (60 patients), 53% received at least 1 screening. Of those patients eligible for breast cancer screening (21 patients), approximately 50% underwent at least 1 screening. Regression results indicated that those patients treated by a pediatric oncologist were >3 times as likely to receive recommended short‐term care. Conclusions The results of the current study highlight gaps in the delivery of posttreatment care to AYA survivors of HL. By determining areas in need of improvement, these findings can guide the development of tailored interventions with which to improve care.

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“…Evidence suggests that this is not the case (Cox and Faithfull 2013) and is reflected in studies that report satisfaction with information provision in people living with and beyond cancer. People with Hodgkin lymphoma who were assessed for cardiovascular risks and participated in a recall screening and counselling service found that the additional information improved satisfaction scores (Daniëls et al 2014). The benefits of screening were seen by people with cancer to outweigh the burden of assessment.…”

Section: Indirect Damagementioning

confidence: 99%

Mitigating risk of cardiovascular disease in people living with and beyond cancer

Faithfull¹,

Burton²,

Clarke³

et al. 2017

Cancer Nursing Practice

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Rates of cancer survival have increased in recent decades as a result of earlier diagnosis and improved therapies, but a longer lifespan does not necessarily equate to a healthier life. Chronic illness as a consequence of cancer and its treatment is reported in a significant proportion of people living with and beyond the disease. An increased risk of cardiovascular diseases, such as myocardial infarction, stroke and heart failure, is one of the side effects of some cancer therapies.Nurses in oncology and primary care can minimise cardiovascular risks by improving people's awareness of symptoms, conducting health assessments and making appropriate referrals. Secondary prevention through lifestyle advice, smoking cessation and obesity reduction is also essential. This should be in combination with more detailed cardiac assessment for those in high-risk groups at all stages of the patient pathway.Appropriate risk management and early detection of heart problems can prevent long-term illness and reduce multimorbidity for people living with and beyond cancer.

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Impact of Cardiovascular Counseling and Screening in Hodgkin Lymphoma Survivors

Cited by 8 publications

References 22 publications

Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment

Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment

Use of recommended posttreatment services for adolescent and young adult survivors of Hodgkin lymphoma

Mitigating risk of cardiovascular disease in people living with and beyond cancer

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