Post-treatment long-term follow up for patients with Hodgkin lymphoma

The authors performed a review of previously published articles on follow-up care for patients with Hodgkin lymphoma. The authors concluded that follow-up treatment should be different depending on how long it has been since treatment, and the types of treatment received.

Hodgkin lymphoma (HL) is generally considered a curable disease. However, relapse is still common. Relapse is most common in the first 5 years after treatment (Years 0-5). There are several ways to detect relapse, including symptoms such as a new lump, a physical exam, computed tomography (CT) scans, positron emission tomography (PET) scans, and chest X-rays.

More than 5 years after treatment (Years 5+), recurrence is less likely. However, late effects from treatment may occur. Some of these late effects include a secondary cancer, heart, or lung problems. 

This review explored the importance of follow-up in the years following treatment for HL.

Years 0-5: Studies have noted that HL recurrence is most commonly identified by patients themselves. Between 45% and 81% of recurrences are detected because patients bring their concerns to their doctor or find a new lump. A chest X-ray and CT scans can also accurately detect HL recurrence. There were conflicting results for the use of PET scans as part of routine follow-up care.

Years 5+: Previous studies have found that breast cancer and lung cancer are the most common secondary cancers. Brest cancer usually occurs 10-15 years after treatment. Between 81% and 100% of secondary breast cancers can be detected by mammography (x-ray of the breast). Breast MRIs have also been found to be very accurate at identifying secondary breast cancers. Women who were treated with chest radiation before the age of 30 to 35 should get a yearly mammogram.

Both radiation and certain types of chemotherapy can increase the risk of lung cancer. The risk for lung cancer is significantly increased by smoking or other tobacco use. The authors suggest that a yearly chest CT scan may be useful for detecting lung cancer in high-risk patients.

Several studies have found that previous HL patients have a significantly increased risk of death from heart disease compared to the general population. This is particularly true for patients who received radiation to the chest area. Echocardiograms or exercise tolerance tests can be used to find risk factors for heart disease. 

The authors concluded that the first 5 years after treatment should focus on monitoring any potential disease recurrence. Follow-up care after 5 years should focus on monitoring for any late effects. 

PET scans have been shown to accurately predict whether patients are likely to relapse following treatment. The authors recommend the use of PET scans to confirm a relapse or recurrence if your doctor is already suspicious.