Hodgkin's Disease

Description

Outlook

Studies indicate that survival rates 15 years after treatment are 85% of all patients. More than 80% of Hodgkin's patients reach complete remission after initial treatment. Unlike other cancers, Hodgkin's disease is even potentially curable in late stages, with up to 85% of patients in late stages surviving 10 years and longer.

The disease recurs after treatment in about 20% to 35% of patients after an average of 10 years, but it is still potentially curable even in these cases. In one study, of those who relapsed two or more years after remission, survival was over 80%. (In other cancers, late stages or relapses are very rarely curable.)

Survival rates are poorest in the following:

• Those who relapse within a year of treatment.
• Patients who do not respond to the first-line therapy, and the disease continues to progress.

Long-Term Effects of Treatments

The good news about Hodgkin's disease is that treatment can cure the disease. The bad news is that survivors face a higher than average risk for long-term complications of these treatments, some very serious.

Many patients may experience chronic fatigue that could persist for years. One study indicated that aerobic exercise may significantly improve fatigue; in doing so it could have a positive effect on mood as well.

The most serious complications are second cancers and heart disease, which occur over the two or three decades following treatments. Secondary cancers include non-Hodgkin's lymphoma, leukemia, melanoma, stomach and lung cancers, and breast and uterine cancers. Combinations of radiation and chemotherapies are especially associated with these problems. Non-Hodgkins lymphomas may be treatment-related but is more highly associated with having HD itself.

The risks for second cancers are highest in younger people and most likely to develop between the ages of 50 and 60 years. The danger for nonsolid tumors declines after five to 10 years although the risk persists for solid tumors for 25 years or more, particularly for stomach, breast, and uterine cancers. Long-term care and monitoring are important. [Complications for the specific treatments are discussed under What Are the Specific Therapies for Hodgkin's Disease?]

Still, in a 2000 study, 20 years after treatment, 90% of patients who had survived treatments were still living.

Researchers are constantly looking for treatments that will be both effective and also reduce the risk for these complications

Quality of Life in Long-Term Survivors

Although HD is highly curable, it can have many psychologic consequences. Depression and anxiety are common in survivors, particularly those who suffer additional medical conditions. Fatigue persists in the majority of patients for years. Still, a 2003 Swedish study reported that although survivors worried about their health and loss of energy, their quality of life did not differ from other people in the population. In fact, they tended to worry less about finances and leisure and placed more importance on family, work, and their relationships with other people.