Hodgkin's Lymphoma Survivors Face Higher Long-Term Heart Risks
Study suggests chemotherapy, radiation can damage the heart for decades to come
MONDAY, April 27, 2015 (HealthDay News) -- While treatment for Hodgkin's lymphoma can beat back the once-deadly cancer, it may also render patients vulnerable to heart disease decades later, a new study shows.
"Physicians and patients should be aware of the persistently increased risk of cardiovascular diseases throughout life," a team led by Flora van Leeuwen of the Netherlands Cancer Institute in Amsterdam, wrote in the report published online April 27 in JAMA Internal Medicine.
According to the American Cancer Society, more than 9,000 people are diagnosed with the blood cancer known as Hodgkin's lymphoma each year. While the disease is now highly treatable, more than 1,100 Americans still die from the illness annually. The disease typically strikes early in life, and is most common in people in their 20s, the society said.
Many patients with Hodgkin's lymphoma recover from their illness, and more than 80 percent live for at least 10 years, the Dutch researchers said in a journal news release. But prior research has linked survival from the cancer to a higher risk of heart disease, possibly due to damage caused by radiation therapy and chemotherapy.
In the study, van Leeuwen's team examined the medical records of more than 2,500 Dutch patients who were treated for Hodgkin's disease between 1965 and 1995, and were diagnosed before the age of 51. The researchers tracked them for as long as 40 years to see what happened to them.
The study uncovered a four- to seven-fold higher risk of coronary heart disease or heart failure in these Hodgkin's survivors compared to people who had never had the disease.
"The results of our study may direct guidelines for follow-up of patients" with Hodgkin's lymphoma, the study authors concluded.
One expert in the United States wasn't surprised by the findings, and said that more must be done to minimize treatment-linked dangers.
"This study confirms what we have known for quite some time now: components of the therapy that enables the majority of patients with Hodgkin's lymphoma to be cured of their cancer and survive long-term, result also in long-term side effects," said Dr. Stefan Barta, assistant professor of medicine at Fox Chase Cancer Center in Philadelphia.
"These long-term toxicities include, but are not limited to, cardiovascular events as described in this study and others, but also second primary cancers, infertility, and thyroid disorders," Barta added.
Findings like those of the Dutch study suggest that a new approach is needed in the care of people with Hodgkin's lymphoma, he said.
"In an era where the majority of patients, especially with early stage disease and favorable features, can be cured of their cancer, we need to focus on reducing the long-term side effects by avoiding overtreatment," Barta said.
He stressed that long-term outcomes may already be getting better for patients. "The study included patients treated between 1965 and 1995. Since then efforts have been made to limit radiation to the [area around the heart] and other vulnerable organs, and reducing the total radiation dose," Barta explained. "Therefore, we hopefully will see less long-term side effects in survivors who were treated in the last 10 to 20 years."
But he stressed that curing patients of their lymphoma must always remain the primary goal, and "long-term follow-up data is extremely important," to assess the effects of treatment on the heart over the patient's lifetime.
There's more on Hodgkin's lymphoma at the American Cancer Society.