Late and Long-term Side Effects of Hodgkin Lymphoma Treatment

Each type of treatment for Hodgkin lymphoma (HL) has side effects that could last for months or longer. And there are some that might not show up until long after treatment has ended. Some side effects, like loss of fertility (ability to have children), heart damage, and low thyroid hormones, can be permanent.

Because so many people are now living for a long time after their treatment, watching for these late and long-lasting side effects is very important. Be sure to talk to your treatment team about what these possible effects might be so you know what to watch for and report to the doctor.

Second cancers

One uncommon but very serious side effect of HL treatment is developing a second type of cancer later on. People who've had HL have a higher risk for many types of cancer. See Second Cancers After Hodgkin Lymphoma for more on this.

Fertility issues

A possible long-term effect of chemotherapy and radiation therapy , especially in younger patients, is reduced or lost fertility. For example, some chemo drugs can affect a male’s ability to make sperm, which might be short-term or permanent. If the patient is old enough and is going to get chemo drugs that can affect fertility, sperm banking should be considered before chemo starts.

Likewise, women may stop having menstrual periods with chemotherapy. This may or may go back to normal; some women go into early menopause after treatment. Radiation to the lower abdomen (belly) can cause infertility unless the ovaries are surgically moved outside the radiation field beforehand. Moving the ovaries does not affect cure rates because HL almost never spreads to the ovaries.

To learn more, see Fertility and Women With Cancer and Fertility and Men With Cancer.

Infections

For unknown reasons, the immune systems of people with HL often do not work the way they should. Treatments such as chemo, radiation, or removal of the spleen (splenectomy) can add to this problem. (Splenectomy was once commonly done, but is now rarely needed.) Patients who have their spleen removed should get vaccinated against certain bacteria.

All people who have had HL should keep up with their flu shots . Getting vaccinations and treating infections right away are very important.

Thyroid problems

Radiation to the chest or neck to treat HL can affect the thyroid gland, causing it to make less thyroid hormone. People with this condition, known as hypothyroidism, may need to take thyroid medicine every day for the rest of their lives. Anyone who got radiation to the neck or upper chest should have their thyroid function checked with blood tests at least once a year.

Heart disease and stroke

People who have had radiation to the chest have a higher risk of heart disease and heart attacks. Though this has become less of a problem with more modern radiation techniques. Some chemo drugs such as doxorubicin (Adriamycin^®) can also cause heart damage. And sometimes the damage isn't seen until more than 10 years after treatment. Your doctor might want to check your heart function for many years after treatment.

Radiation to the neck increases the chance of stroke because it can damage the blood vessels in the neck that supply the brain. Ultrasound may be used to check the health of the blood vessels in your neck.

Smoking, high cholesterol, and high blood pressure (hypertension) also increase the risk of heart disease and stroke. It’s important to do what you can to help lower your risk, such as not smoking, staying at a healthy weight, being active, and eating a healthy diet. It’s also important to have regular check-ups with your doctor and get treated if you have high blood pressure.

Lung damage

The chemo drug bleomycin can damage the lungs, as can radiation therapy to the chest. This can lead to problems like shortness of breath, which might not show up until years after treatment. Smoking can also seriously damage the lungs, so it’s important that people who have had these treatments do not smoke.

Special concerns in childhood Hodgkin lymphoma survivors

Just as the treatment of childhood HL requires a very specialized approach in children, so does follow-up and monitoring for relapse (HL coming back) and late effects of treatment. Careful follow-up after treatment is very important and it should be done for the rest of the child's life. The earlier problems are found, the more likely it is they can be treated effectively.

Along with physical side effects (including those listed above), survivors of childhood lymphoma may have emotional or psychological issues. They also may have some problems with normal functioning and school work. These can often be addressed with support and encouragement. Doctors and other members of the health care team can also often recommend special support programs and services to help children after treatment.

To help increase awareness of late effects and improve follow-up care for childhood cancer survivors throughout their lives, the Children’s Oncology Group (COG) has developed long-term follow-up guidelines for survivors of childhood cancers. These guidelines can help you know what to watch for, what types of health screening should be done, and how late effects may be treated.

It’s very important to discuss possible long-term problems with your child’s health care team, and to make sure there's a plan in place to watch for these problems and treat them, if needed. To learn more, ask your child’s doctors about the COG survivor guidelines. You can also download them for free on the COG website: www.survivorshipguidelines.org. The guidelines are written for health care professionals. Patient versions of some of the guidelines are available (as Health Links) on the site as well, but we urge you to discuss them with a doctor.

For more about some of the possible long-term effects of treatment, see Children Diagnosed With Cancer: Late Effects of Cancer Treatment.