Prevalence of function‐limiting late effects in Hodgkin lymphoma survivors

Abstract

Background: Hodgkin lymphoma (HL) is highly curable, but survivors often develop function-limiting impairments. Screening guidelines for neuromuscular and musculoskeletal late effects are not as well recognized across medical disciplines. Early identification and management of functional late effects are instrumental in improving the longitudinal care of HL survivors. Objective: To define the prevalence of neuromuscular, musculoskeletal, visceral, oncologic, and other late effects affecting function and quality of life (QOL) in HL survivors. Design: A retrospective cohort analysis. Setting: Outpatient cancer rehabilitation clinic. Participants: One hundred HL survivors. Interventions: Not applicable. Main Outcome Measures: Prevalence of neuromuscular, musculoskeletal, visceral, oncologic, and other late effects contributing to functional impairment and disability in HL survivors.Results: Among the 100 HL survivors, 43% received chemotherapy, 94% radiation therapy, and 38% a combination of chemo-radiation for their initial cancer treatment. Nearly all HL survivors were diagnosed with myelopathy (83%), radiculoplexopathy (93%), mononeuropathy (95%), and localized myopathy (93%). Musculoskeletal sequelae included dropped head syndrome (83%), cervicalgia (79%), shoulder girdle dysfunction (73%), and dysphagia (42%). Visceral disorders included cardiovascular (70%), pulmonary (44%), endocrine (63%), gastrointestinal (29%), and genitourinary (11%) dysfunction. Lymphedema affected 21% of survivors and 30% had a history of a secondary malignancy. Pain (71%), fatigue (45%), and dyspnea (43%) were major function-limiting impairments. Nearly all (95%) of survivors were referred to at least one therapy discipline including physical therapy, occupational therapy, speech and language pathology, and/or lymphedema therapy. Conclusion: Neuromuscular, musculoskeletal, visceral, oncologic, and other late effects are extremely common in HL survivors seeking physiatric evaluation. Multiple function-limiting disorders can coexist in HL survivors with the potential to severely compromise function and QOL. Safe and effective rehabilitation may depend on the physiatrist's ability to identify, evaluate, and manage the multitude of complex and often interrelated functional late effects seen in HL survivors.

Proposal of a diagnostic algorithm for radiation-induced dropped head syndrome in long-term childhood cancer survivors based on a prospective study in a specialized clinical setting and a review of the literature

“…MRI con rmed signs of cervical muscle atrophy in 80% of these cases, whereas muscle atrophy could not be detected in CCS without clinical or neurological signs of DHS who received MRI as part of their routine cancer follow-up. Few former studies indicated a much higher prevalence of radiation-induced DHS in HL survivors up to 83% in a recent analysis in which, however, diagnosis of DHS was solely based on subjective weakness in head elevation or weak cervical paraspinal muscle contraction demonstrated during palpation on physical exam [30]. Furthermore, only survivors visiting a cancer rehabilitation outpatient clinic for functional impairments have been included [30] so that, similar to another study on progressive muscle atrophy in HL survivors in which a relevant share of potential survivors could not be included in the study due to multiple reasons [8], data did not allow to draw conclusions on the true incidence of radiation-induced DHS in an unselected cohort of CCS.…”

“…Few former studies indicated a much higher prevalence of radiation-induced DHS in HL survivors up to 83% in a recent analysis in which, however, diagnosis of DHS was solely based on subjective weakness in head elevation or weak cervical paraspinal muscle contraction demonstrated during palpation on physical exam [30]. Furthermore, only survivors visiting a cancer rehabilitation outpatient clinic for functional impairments have been included [30] so that, similar to another study on progressive muscle atrophy in HL survivors in which a relevant share of potential survivors could not be included in the study due to multiple reasons [8], data did not allow to draw conclusions on the true incidence of radiation-induced DHS in an unselected cohort of CCS. Our proposed algorithm for radiation-induced DHS diagnosis showed good reliability and practicability in a clinical setting without risks of radiation exposure or invasive procedure.…”

Embracing Complexity—the Role of Cancer Rehabilitation in Restoring and Maintaining Function and Quality of Life in Cancer Survivors with Radiation Fibrosis Syndrome

“…No group of cancer survivors better exemplifies our need to embrace complexity more than those afflicted with radiation late effects—particularly those treated for Hodgkin lymphoma (HL) and head and neck cancer (HNC). A recent retrospective cohort analysis of 100 consecutive HL survivors evaluated and treated in the outpatient cancer rehabilitation setting demonstrates that nearly all had neuromuscular dysfunction including subacute myelopathy (83%), radiculo-plexopathy (93%), mononeuropathy (95%), and localized myopathy (93%) or a combination of all termed “myelo-radiculo-plexo-neuro-myopathy” [ 3 •]. Dropped head syndrome (83%), cervicalgia (79%) and shoulder girdle dysfunction (73%), and pain (71%) were some of the most common disorders seen.…”

“…A more medically focused review listed loss of saliva, osteoradionecrosis, radiation recall myositis, pharyngoesophageal stenosis, dental caries, oral cavity necrosis, fibrosis, impaired wound healing, skin changes and skin cancer, lymphedema, hypothyroidism, hyperparathyroidism, lightheadedness, dizziness and headaches, secondary cancer, and eye, ear, neurological, and neck structure damage as late effects [ 5 ]. Baroreflex failure is considered rare but likely underrecognized and diagnosed in HNC and HL survivors [ 3 •, 6 ]. Radiotherapy-induced carotid toxicity is common in HNC and likely other groups such as HL survivors [ 3 •, 7 ].…”

“…Baroreflex failure is considered rare but likely underrecognized and diagnosed in HNC and HL survivors [ 3 •, 6 ]. Radiotherapy-induced carotid toxicity is common in HNC and likely other groups such as HL survivors [ 3 •, 7 ]. This laundry list of issues faced by these survivors is by no means complete but is given to emphasize the challenges in optimally managing such patients.…”